Loose Strife

One way of tracking the progression of cancer and the efficacy of treatment is the measurement of various quantities in blood samples that are statistically associated with cancer growth. There is some controversy about these, but taken along with other indicators are useful.
Laura received the results of her second measurement of “CA 27-29” today and it was higher than a month ago at the time of her diagnosis. This isn’t a cause for concern yet because Tamoxifen is slower acting than chemo and the trend over several months is more important.
In fact, there’s a lot of reason to be optimistic at this stage. It’s quite possible that Laura could ride a wave of new cancer treatments. First, women with hormone receptive breast cancer respond better to treatment because of the availability of multiple hormone therapies. Second, while the published median statistics on “BC mets” (metastatic breast cancer) are poor, it’s important to realize that they are based on all breast cancers (hormone receptive or not) over the last 40 years. Many new hormone therapies have been developed during the last 10-15 years and it’s likely that more will become available in the next decade. (It’s typical for someone with mets to change to a new treatment when an old one stops working after months or years, but usually not more than five years for any one drug.)
Another reason for optimism is that the usual statistics are based on all mets cases, regardless of previous history. Someone with mets due to recurrence or because of a failure of treatment for earlier stage breast cancer is likely to have a worse prognosis than someone in Laura’s situation who was diagnosed with mets from the get go. In other words, Laura has a better chance of responding to therapy than other stage IV patients who may have been battling cancer for a long time. In our case, it’s just the beginning and there are many treatment options to try.
The last reason for optimism is that Laura is under excellent care, has a strong reason to fight, and has lots of support from family and friends. These factors cannot be underestimated and should help to place her in the “positive tail” of the distribution.
Stephen Jay Gould is a famous evolutionary biologist who had a very rare type of cancer called abdominal mesothelioma, which he managed to keep at bay for tens of years longer than the median estimate. He wrote an excellent article called “The Median Isn’t the Message” that explains both the importance of statistics and the reasons for optimism given the statistics.