A Final Word On Risk Factors

Okay, maybe this post’s title is a lie, since I keep bringing this topic up. But I admit that I need to stop whining about getting breast cancer when I didn’t have risk factors, so I’m officially giving myself one last time to vent. And then it’s time to let it go.

First, what is a risk factor? The NIH National Cancer Institute dictionary defines a risk factor as “something that increases the chance of developing a disease”. However, that does not mean that it’s necessarily a cause of that disease. And that’s where the potential confusion (and in my case, irritation) arises.

While breast cancer has a number of risk factors, none of them are 100%-for-sure causal in nature. Even having the BRCA gene does not guarantee that you’ll get breast cancer, although your risk is quite high.

So why does this matter? Turn this around and look at someone with breast cancer. Based on risk factors, you’d expect them to be overweight, sedentary, a smoker, a drinker, an unhealthy eater…and you might be completely wrong. Ascribing unhealthy behaviors to an individual just because they are a cancer patient is potentially stigmatizing (it suggests that they are responsible for bringing on their disease) and ignores the fact that we still don’t know why cancer develops. And what of all those making poor health choices who do not get cancer?

Engaging in the opposite behaviors — being a lean, active, non-smoker, non-drinker with a plant-based diet — likewise is not guaranteed to protect you from breast cancer. And yet, that’s exactly the feeling you get from reading all the recommendations, which leads to a potentially dangerous false sense of security.

Risk factor, schmisk factor! Putting in the effort to live as healthfully as possible is well worth it, no matter what.

Certainly, no matter what disease you have, the more healthy behaviors you engage in, the better your outcome. However, even being a paragon of healthy living is not the “get out of cancer jail free” card that we are led to believe it is. So get yourself checked out and don’t take your health for granted!

What brought all of this up? At a recent gathering, I had an interesting conversation with another former cancer patient who also happens to be a medical psychologist. She felt as frustrated as I did about the way cancer risk factors are presented, so I felt a vindication of sorts. We both agreed that it is critical to highlight the difference between cancer risk factors and causes. And of course, no matter what your perceived cancer risk, to live as healthfully as possible.

Now that I’ve gotten that off my chest, I will do my best to shut up and move on.

Exercise, Eat Right and Get Cancer Anyway

I need to get this off my chest (no pun intended), because it drove me absolutely nutso for a long time. As far as I was concerned, there was no reason whatsoever for me to get breast cancer, and a gazillion reasons for me not to. I had fantasies of taking the breast self-exam instructional card that hangs in our shower and running it through the shredder, flipping it off as it disappeared into the steely maw. That’s because on the backside of the card were guidelines to reduce one’s risk of getting breast cancer, and it was infuriating how anemic the suggestions were, as in, they were setting the bar pretty low: “maintain a healthy weight” (been doing that for a long time), “add exercise into your routine”, (are you kidding me? Strength training, rowing, the whole nine yards!), “limit your alcohol intake” (WHAT? I don’t even freakin’ drink!!!). Every time I looked at that card, I fumed. I had gone to great lengths to follow health rules to a T, always erred on the side of caution to the point of being anal about it. When my doc felt the breast lump that I pointed out to her–the one that I’d felt for a good six months but had not gotten checked out because I had no risk factors and I was always fretting about health stuff that turned out to be nothing and I didn’t want to waste the co-pay and the lump was probably going to go away on its own soon, blah blah blah–I was shaken by both her obvious concern and the warning not to put off getting the diagnostic mammogram done.

Obviously, things did not turn out as I’d hoped. Ergo, this blog…

Following all these guidelines touted to reduce your risk of breast cancer, and then being the one among all my relatives to get it was intensely frustrating. I was the health nut, the vegetarian, the exerciser, habits for which I’d gotten my share of ribbing.  I spent a lot of time angry about this, searching for answers why. Maybe there was something I had missed? Was it the plastic straws? Contaminated toothpaste? Radiation from outer space?

Then there was the emotional fall-out, an effect of my perfectionist tendencies. I felt shame, as if I were being judged and people would think that I must not have been “following the rules”. Were they gloating at me? Other women who were not paragons of healthy living didn’t have cancer. But I did? I felt the need to explain myself, as if I risked getting kicked out of some “healthy persons’ club”. There is a popular expectation that the only time people my age exert themselves is when they’re chased by their neighbor’s pitbull. Or running down a Black Friday special. But to actively work at maintaining a healthy existence for the sake of maintaining a healthy existence and presumably a healthy future? Not the typical 50-something. I prided myself on being different and was free of health problems for years, but getting smacked down by cancer…that’s a pretty big one. So was all the effort and exercise and veggie consumption worth it?

Undoubtedly.

What helped calm my anger was looking at my situation this way: Would I not have gotten breast cancer if I ate meat? Or was overweight? Would I have been spared if I drank alcohol or smoked? Or led a sedentary existence?

While following all the rules and recommendations didn’t prevent my cancer, I can unequivocally say that it accelerated my recovery. And I do not for a second regret the effort that went into that focused mindset. Yes, I still wanted to feed the breast self-exam card to the shredder. Many times. But that’s because I forgot that statistics are great for defining populations, but ultimately they don’t matter when it comes to the individual. When you have cancer, your chance of having cancer is 100%. I wanted answers, but so does every cancer researcher out there. As my surgeon reminded me, “If we knew why, we could cure it.” And I’d be up for a Nobel prize.

So, I don’t know why. Of course, since I’ve mulled this over and over, I’ve got a load of theories, some more convincing than others. It’s part of my nature to want to know the why so that I can feel a sense of control over what is a very frightening disease. But I don’t have that. I do, however, have a determined nature and am happy to eat plant-based foods and find pleasure in exercise, and for the time being I will be content in that.