The only perfect cancer statistic is an imperfect one


As an oncologist, I spend my days with women and men diagnosed with cancer. My patients, particularly my advanced-stage or Stage 4 (metastatic) patients, often ask what they did wrong. How did they end up with metastatic cancer? They share with me the subtle accusations made by friends, family and acquaintances that somehow they brought this on themselves. “If only Susan had done her screening mammograms faithfully, she never would be in this position.” “Did you hear Bob has metastatic melanoma? I bet he wishes he had worn sunscreen!” “I’m sorry to hear that your cancer came back  — did you follow your doctor’s recommendations?” The talk about risk factors and early detection makes us think we can achieve perfection, and that cancer is somehow a personal fault.

Risk, however, is inevitable despite our best efforts. I believe in screening for early detection of cancer. I practice lifestyle modifications that can lower my risk of developing cancer. I have spent years of my life applying sunscreen to my children and myself. I have never smoked. I eat well and exercise regularly. I will dutifully get my mammograms, pap smears and colonoscopies. I still could get cancer. Statistically speaking, there is a 33 percent chance I will get cancer despite the fact that I am “low risk.” One in three women will get cancer in her lifetime. My husband, who shares my zeal for health, has a 50% lifetime risk. (One out of every two men will get cancer.) All this practice can improve my batting average, but I am still at risk to strike out.

The best hitters in baseball — men like Stan Musial, Ted Williams, or more recently, Albert Pujols — do everything right. They have perfect form, benefit from the best hitting coaches and practice consistently. Nevertheless, they still strike out. A quick Google search tells me Albert Pujols has struck out 1073 times in his career. Maybe he is doing something wrong after all?

Just like Hall of Fame hitters, many persons diagnosed with cancer have also done everything right. I have patients in my practice who have died of Stage 0 or Stage 1 breast cancer. They were low risk. They did their screening mammograms. They had perfect surgeries, radiation and standard of care chemotherapy, dramatically lowering their risk. They took their pills without fail. They came to every appointment. And here we are. A new symptom, a mass somewhere on a CT scan and a biopsy that confirms their cancer is back. “Doc, what did I do wrong?” Nothing. Sometimes the best still strike out. Imperfection is the only perfect statistic.

In the example of breast cancer, approximately 40,000 people will die of the disease this year. It is not the fault of the patient. It is the fault of the disease. The risk of death rises based on the stage at diagnosis and features of the cancer, but even persons with early stage disease can have fatal recurrences. I wish that recurrence or metastases would never happen. I wish that I could promise patients with 100 percent certainty that if they follow my advice, they will be cured and live cancer-free forever. It is my job as an oncologist to coach your best game, to improve your batting average. Like my Major League Baseball counterparts, I know hundreds of statistics. While they use data to predict their success based on the pitcher (handedness, type of pitch, location of pitch), I use data to predict what is best for my patient. I recommend everything reasonable to make risk as small as possible while maximizing benefit. In the end, we are just standing at the plate, waiting to see what happens on this at bat. We have put in all the work necessary for perfect statistics. Will it be a homerun? Or will we strike out?

I am proud of all of you for practicing good adult health maintenance. For doing your screenings. For making healthy choices. You are improving your batting average. You are improving my career wins. I am proud of Pujols for all the time he spent in the weight room during the off-season. For all the practices. For the hours spent reviewing tape. His statistics are astounding.

So let us stop making accusations and blaming persons diagnosed with cancer. They are blameless. Their turn at the plate just did not end in a home run. And if you happen to bump into Albert Pujols, you probably shouldn’t give him batting advice either. He works hard for stats like that. Unfortunately, cancer and baseball never promise 100%. They are games of imperfect statistics.

Stephanie Graff is an oncologist and can be reached on Twitter @DrSGraff.

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