10/26/2007 11:55 am ET Updated Nov 17, 2011

Failing at Cancer: Part II

The road to failure exists even before the possible journey into illness begins. This is because research shows that some women overestimate their risk of getting breast cancer, even after they've been told by doctors that statistics make them less at risk than they think. While it isn't clear what causes this "resistance to good news," the researchers found that pessimism and "differences in understanding percentages" (presumably, being bad in math) -- had nothing to do with it. Yet just as being overly negative is unacceptable, women who underestimate or ignore their high-risk status by not going for regular diagnostic mammograms or genetic tests are routinely criticized for being in denial about their increased chances for having breast cancer.

A close friend of mine who writes a national advice column which dispenses, among other things, health and medical advice to millions of readers, had her first mammogram last spring at the age of 48 despite her strong family history of breast cancer, and was pilloried by all of her friends for being so inexplicably remiss. By the time she was in the waiting room with her Johnny on, waiting for her results, she was convinced of two things: 1) that she was a complete idiot for having waited so long to get a baseline mammogram and 2) that if the mammogram led to cancer being found, no one would have any sympathy for her.

It's the (relatively) lucky cancer patient who makes it through the first stop to Cancerland -- finding a suspicious lump -- unscathed -- lucky because he or she will have found and caught their own cancer themselves in time to survive their diagnosis. With breast cancer, "self-examination" is where countless women enter instant failure-mode -- either because they forget to check their breasts, feel uncomfortable checking their breasts, or don't know exactly what they're supposed to be checking for. If a woman walks into her doctor's office sporting a fully formed lump, the points she earns for being self-aware and pro-active will be reduced for either having failed to find the lump sooner or failing to call a doctor sooner after finding the lump. This is assuming, of course, that the lump is actually a lump, and not just some stupid cyst or swollen lymph node or patch of dense breast tissue. If the lump being palpated during the office visit fails to be anything more than a false alarm -- not even serious-seeming enough to warrant an ultrasound -- let alone a biopsy -- the woman leaves the office feeling like a hypochondriac, a worrywort, a neurotic oncologistical time-waster.

The next stop is the diagnosis itself -- confirming what kind of cancer you have and what stage it's at. This is also known as the How could you not have noticed this sooner? or the Why did you wait so long to get this looked at? phase. Depending on the stage of development -- early or late -- you can yet again be blamed for failing to notice the cancer in time for it to be successfully treated. Which means it will be your fault if you die.

Last year, at the same time that I was feeling lucky that my breast cancer was caught at such an early stage it was barely even cancer -- for a while I had been so confused by the initial explanation of my Stage 0 diagnosis that I thought I had a pre-cancerous type of cancer that wasn't really cancer! -- I was also feeling incredibly guilty: another close friend, Jana, had just been diagnosed with breast cancer, too. Only her situation was much worse than mine: instead of a few self-contained splotches of non-invasive cells, a large tumor had been hiding so far back behind her right breast almost against the rib cage that it had grown to the size of a lemon. It was only when the tumor caused her nipple to invert that she went to see her doctor -- the lemon-sized tumor itself she had never even felt.

Despite the fact that even my friend Jana's doctor had trouble feeling her large tumor -- even after knowing its exact geography with the help of an MRI -- no one could believe that she hadn't felt it at any point as it was getting bigger and bigger. Aside from having to process her Stage 3 diagnosis and aggressive treatment plan, one of the worst things about her situation early on was everyone asking her how she could possibly not have felt it.

"I felt like an idiot for not feeling my tumor and for basically only taking notice when my breast became disfigured," she told me, completely unaware of the fact that she had quickly gone from cancer victim to blame-the-victim cancer victim and that her sense of failure would only increase exponentially over the coming months.

Next is the assumption that unless you instantly become an expert in cancer -- something doctors go to medical school for years and years to achieve -- finding out about and understanding your own particular form of cancer and the treatments for it, all the cutting edge research and possible experimental treatments, all the best doctors and hospitals that provide those treatments that have the highest survival rate for your specific cancer -- you could later be held responsible for Failing to take an active enough role in your own recovery. This is yet another version of the It will be your fault if you die category and the easiest way to fail the Become an oncologist in two weeks or less test.

Blaming the cancer victim really gets going at the next stop: the moment at which you secretly begin to wonder if it actually is your fault for getting cancer. "First I thought I'd gotten cancer because I didn't play enough sports in school," Jana told me. "Then it was because I never had children." Her list went on and on as did mine, and as does every woman's once she's been diagnosed:

Was I stupid enough to take the pill?

Lazy enough to not take vitamin supplements?

Vain and insecure enough to use deodorant and hair dye?

Gluttonous and slovenly enough to wait right in front of the microwave oven while preparing processed foods that made me fat around the middle?

"The more patients are encouraged to take responsibility for their health success, the more liable they are to feel culpable when their health fails," writes Richard Gunderman in Illness as Failure: Blaming Patients. Anyone diagnosed with cancer in the last 20 years, myself included, can undoubtedly attest to the validity of that statement.

The wondering quickly turns to suspiciousness when you start hearing about the "cancer personality." The fatuous cancer personality is something Susan Sontag tried to debunk over 30 years ago in Illness as Metaphor (and again ten years ago when she made the same case for AIDS), and it still persists today masquerading in touchy-feely mind-body-connection clothing as the belief that an unfailingly positive attitude is an absolute requirement for surviving cancer. Despite the fact that everyone knows someone who's died of cancer despite their positive attitude and irrepressible will to live, this belief in the link between human failure and cancer development remains, encouraging people, as Sontag wrote, "to believe that they get sick because they (unconsciously) want to, and that they can choose not to die of the disease."

But whether someone becomes ill "by choice" or as a kind of Biblical payback for sinning -- basic current medical wisdom has "transformed venerable moral vices such as sloth, gluttony, intemperance, and fornication into medical risk factors: sedentary lifestyle, obesity, alcoholism, and unsafe sex" -- even the kind of stories that are acceptable to tell about cancer are limited to one type only: heroic stories of miraculous recovery. Sad depressing negative stories about failing to recover from cancer are rarely seen because exposure to all that negativity could cause people with the cancer personality even more cancer.

This is Part II of a multi-part series.