Here’s a quiz.
Which of these would you rather have?
- Stage 3 triple negative breast cancer that has no genetic component
- Stage 2 hormone-positive breast cancer as a result of hormone replacement therapy
- Stage 2 hormone-positive breast cancer with a BRCA1 gene mutation
- Stage 4 malignant melanoma
Well of course, your answer should be “none of the above.”
But for some who have been placed on the path through Cancerland, this question actually begins a strange competition.
Which of these options is the best choice? Let’s take a look at the facts.
As cancer goes in general, the higher the stage, the deeper the trouble. Early stages (1, 2 and possibly 3, depending on who’s defining it) are generally considered curable. Stage 4, in which the cancer has spread to other areas of the body, can be treated but is not generally considered curable. Given this ranking, you might assume that a stage 2 cancer is preferable to a stage 3. And you might be right.
But then, with breast cancer, there’s the issue of hormone receptivity. In general, patients with the so-called “hormone-receptor” breast cancers (ER+, PR+, HER2-) have a wider range of choices for treatment – “targeted” therapies such as Tamoxifen and Herceptin – which have vastly improved outcomes for patients with these types of breast cancer, compared to the triple-negative variety, in which the cancer has no (or few) hormone receptors and no targeted therapies (yet). Given this information, you might think it’s better to have a hormone-receptor positive type of breast cancer. And again, you might be right.
But recent research shows that the hormone-receptor cancers are often less sensitive to chemotherapy than are triple-negative cancers, and they have a higher likelihood of recurrence for a longer period of time. As my oncologist put it, the breast cancers that return after 10 or 12 years tend to be the hormone-positive variety. And research also shows that drugs like Tamoxifen present problems of their own and should not be used for long periods of time.
Once you add in the effects of genetic mutations, the picture becomes increasingly complex. Is it better to have a stage 1 tumor with a genetic mutation (BRCA1 or BRCA2)? Or to have a stage 3 tumor without? Stage 1 is generally better than stage 3, but a genetic mutation puts you at higher risk of recurrence, and ovarian cancer as well.
Are you confused yet?
The point of my analysis is this: The competition is pointless.
Cancer is cancer, and none of the varieties is preferable. This is a disease you don’t ever want to have in any form. Even if it’s one of the curable types or stages, you can never know for sure if you’ve been cured, until you die of something else.
Those who play the game of Competitive Cancer do so for one simple reason: to make themselves feel better. The word cancer introduces a person to a fear like no other. One of the ways we humans deal with fear is to tell ourselves that “it could be worse.” And to reinforce that false assurance, we compare our situations to those we imagine are worse than ours.
The truth is, there is no way to predict, for any individual, what the outcome will be based on the type of cancer diagnosed. The survival and recurrence statistics only follow trends, and those trends are always in the past because you can only count the numbers after the fact. They do not dictate what my or your particular experience on Cancer Road will be. Elizabeth Edwards started out with a stage 2 hormone-positive cancer in 2004. It metastasized to her bones and liver and lead to her death in 2010. An acquaintance of mine, diagnosed 2 years ago with Stage 4 malignant melanoma, lapsed into a coma in which she says she actually saw her ancestors coming for her. Today, by the miracle of an experimental treatment, she is attending yoga classes and recently took a trip to Chicago.
So, which type of cancer wins the Cancer Competition?
None of the above.
None of them at all.