May 20, 1994

3.On Having Cancer

Don't be afraid of giving yourself away, for if you write, you must. And if you can't face that, better not write.

Katherine Anne Porter(1890-1990)

My personal introduction to the world of human cancer came three years ago when I noticed a small lump in my left breast. I thought that it would be interesting to watch it and see what it would do, in much the same way as I used to watch similar tumors in mice, when I was a cancer biologist. So, for a month, I watched it. It didn't seem to do anything. If it was growing, it was doing so very slowly. It was very interesting. I wasn't worried; after all the chances of a male getting breast cancer were a hundredth that of a woman. That meant that the odds of my getting breast cancer were about one in a thousand. At the time, I didn't consider the fact that I had a tumor for sure. I have the same capacity for self-delusion as anyone else. The question now was whether that tumor was benign or cancerous. The probability of the tumor being cancer was more in the neighborhood of one chance in four; not one in a thousand.

I mentioned to my wife that I had a small lump in my breast. Her face turned white.

"Where?" she asked.

I showed her where it was and she touched it. "You do have a lump," she said. "What are you going to do about it?"

Up to that point I wasn't going to do anything except watch it. I suddenly realized that if our roles were reversed, and that lump was in her breast, that I would insist that it be checked out immediately. I doubt that she would have spent a month just looking at it.

"I'll go to see the doctor this week," I said.

A few weeks later, I was lying on an operating table, while Dr. Hugh Curtis removed the lump under a local anesthetic. He showed me the tumor which he had cut in half. It looked soft and it seemed as if the cut surface bulged. It was not the hollow cyst that I had expected. Neither was it the hard fibrous mass that is associated with benign tumors. I made some inane joke about his making sure to do a good sewing job so that he wouldn't jeopardize my modeling career. That was on Friday.

On Tuesday the pathologist's report came through. It was an adenocarcinoma, a cancer of the breast. Then it hit me that, just like in the movies, that little lump could end my life. Lots of people die of breast cancer. What were the realities? I just didn't know.

On Thursday, after the stitches were removed, I went to visit the pathologist. He showed me the slides and I looked at the cancer under the microscope. I looked for the obvious things, like the organization of the tissue, the size and shape of the nuclei, the numbers of mitotic(cell division) figures. If it had been a mouse tumor, I would have known much more. I have not been formally trained in pathology. I picked pathology up as I went along; without the apprenticeship where I would be told by the master that that was an intraductal papillary adenocarcinoma. I got my doctorate in Zoology and I was an experimental pathologist, I worked with mice, not people. I couldn't look at a human tissue under the microscope and divine what it might do.

While I was behaving both logically and competently on the surface, the small panicked child inside of me was shrieking, at the top of his lungs, "I don't want to die!!"

I decided that I would get that treatment that had the best chance of curing the cancer; which was mastectomy. My surgeon convinced me that there were advantages to a modified radical mastectomy in that it would yield information about whether the cancer tended to spread, even if it might not necessarily contribute toward a cure. Since the odds were about 1 in 40 that there would be cancer developing in the other breast, I asked that he also remove it as well. I have a thing about preferring to look symmetrical. While I didn't relish the surgery, I wasn't unhappy about losing both breasts. I can now testify that losing both breasts is no more painful than losing just one. Now I don't have to worry about the possibility of another cancer developing in my other breast.

I figure that the whole business cost me a painful and very unpleasant year. If I were younger, I would probably have recovered faster. Many people report feeling back to normal after a couple of months.

While the odds in favor of my having been completely cured are very good (better than 90%), the truth of the matter is that I really don't want to play that odds game at all.

How am I dealing with it now, three years later? I am assuming that I have been cured by the surgery. I know that that might not be true, but every year that goes by makes it more likely. Dwelling on death is a miserable way to live, and I intend to really live until my time comes to die.

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