Probabilities

In last Thursday’s Science section of the Times, Peter B. Bach, a cancer researcher and physician at Memorial Sloan-Kettering Cancer Center, wrote about the probabilities of a cancer’s recurring. He and his wife, who had recently been diagnosed with breast cancer, asked his colleague, a world-renowned expert on breast cancer, what the probabilities of a recurrence would be. One chance in twenty? One chance in fifty? The expert, who knew the statistics as well as anyone, didn't give him a direct answer. He said the answer didn’t matter. The cancer would either recur or it wouldn’t.

When pressed to give an answer – after all, Dr. Bach, himself an expert, could readily find the statistics himself – his colleague said that he would provide the data if the couple would tell him what number would make them decide to act differently. To this they had no answer. No matter how low the probability, Dr. Bach wrote, the couple could not be confident that the cancer would not recur, and no matter how high the probability, the couple would continue living their lives.

Unlike Dr. Bach’s wife, I recently learned that my cancer has returned. This was a surprise, because after a two-month course of radiation ending in December of 2007 – with radiation five times per week and a longer course of hormone therapy - I had assumed that the dragon had been slain for good. Perhaps I had been lulled into complacency by my first experience with cancer, which had been excised in 1991 and had never returned. But if I had known that the dragon had only been wounded and would rise and fight again, would I have acted any differently? Would I have bought a red sports car? Traveled to Machu Picchu? Joined an ashram in Varanasi? No. I would have behaved much as I’ve been acting since the end of my radiation.

Dr. Bach wrote that Stephen Jay Gould, the Harvard paleontologist, convinced himself that he would beat the dismal odds presented by his deadly form of cancer. He told himself that he would be among the rare long-term survivors. And indeed he was. He lived for another 17 years after his diagnosis. Dr. Bach concluded that Gould chose to deceive himself, and I suppose that’s true. Yet during that time Gould lived an active life, continuing to be a productive researcher and science writer. My guess is that Gould would have continued his work even if he hadn’t such an optimistic view of his longevity. Still, his rose-colored assessment may have helped him forget the axe over his head.

As for me, I won’t ask my doctor to tell me the odds for my survival. I either will or I won’t survive this round. In the meantime, I’ll do my best to derive as much experience as possible from every day that’s left. In any case, the older we get, the more likely it becomes that some axe - whether from cancer, from some other disease, from an accident, or from simply wearing out - will fall on us. By now, after all, the string by which that axe is suspended is fraying. So hey, maybe buying a red sports car isn’t such a bad idea. First, though, I’ll have to convince the Department of Motor Vehicles to give me a driver’s license.