Food, Inglorious Food - Part IV

Note: This is the fourth (and final, I promise!) post in this series. For background, read Part I first.

Again, here are my three simple reasons for trying to eat a healthy diet:

1. Maintain my weight. See Part II of this series.
   
   
2. Manage my cholesterol. See Part III of this series.


3. Within reason, avoid anything that might somehow trigger a future breast cancer.
   
   What are the odds that in the midst of a four-part post on diet and nutrition the World Cancer Research Fund and the American Institute for Cancer Research would publish an exhaustive report called "Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective"?
   
   Well, buy your lottery tickets, ladies and gents, because that's what happened today. And while I haven't had the chance to read all 517 pages, I did check out the section on breast cancer as well as the authors' overall recommendations.
   
   From what I have seen so far, my first goal above is right on target: the report is laced with references to excess weight (particularly around the abdomen) and adult weight gain as probable or even persuasive causes of breast cancer.
   
   Physical activity is also cited as a likely protector against breast cancer in post-menopausal women. (Exercise will be the next topic I tackle in what began as Breast Cancer Self-awareness Month but is clearly going to extend beyond the stroke of midnight tonight.)
   
   Based on the report, there are at least two things I should significantly limit in my diet: alcohol and processed meats.
   
   "The evidence that alcoholic drinks are a cause of breast cancer at all ages is convincing," the report says, and it's hard to imagine language starker than that. I've never been much of a drinker, so I don't expect to have to make a major lifestyle change here. The difference between a glass or two of wine a month and none at all is negligible and therefore not something I'm going to worry about.
   
   Meats that have been processed—salted, smoked, cured, or treated with preservatives—are likewise not a huge component of my diet. I have a slice or two of bacon maybe once a quarter, and only the nitrate- and nitrite-free kind at that. It's true that I am a fan of smoked turkey, but I am picky here, too—no nitrates or nitrates, organic when possible. Still, I will probably try to drop my consumption from occasional to very infrequent.
   
   I have to confess that there are two things I have consciously—and conscientiously—restricted from my diet ever since my first round of breast cancer, back in 2001, even though there hasn't been clear and convincing evidence of the need to do so.
   
   The first is meat or dairy products that were or might have been treated with hormones. Both of my tumors were hormone-driven, and I'm just not willing to take a chance that something I eat could provide any kind of fuel for hungry cancer cells that might still be in my body. I will feed a cold, but I'll be damned if I'm going to cater meals for cancer. The authors of today's report demurred on this question, citing a lack of epidemiological or other evidence.
   
   The other thing I eschew is soy, which can mimic estrogen in the body—that's why it's sometimes touted as a way to help mitigate the side effects of estrogen deprivation, such as hot flashes, that come with menopause. (I say this by way of explanation only—it's a fraught topic, and one that I am not remotely qualified to judge. I am absolutely not making a recommendation of any kind.)
   
   I never liked tofu, so that hasn't been a major loss. But I do like edamame and no longer have it. And I also avoid all of those nutrition bars marketed to women, because they feature soy as an ingredient.
   
   I took a special look at the report to see if there was news about soy (or "soya," as they call it), and here's what it says:
   
   "There is considerable speculation around a biologically plausible interaction of soya and soya products with breast cancer development, due to their high phytoestrogen content. . . . [T]here were insufficient studies available on soya consumption to allow a conclusion to be reached."
   
   The authors of this report spent six years working on it and reviewed more than 7,000 studies in the process. If they are unable to reach a conclusion about something, what is a layperson to do?
   
   In my case, I will do what I have done for the past six-plus years: make the best decisions I can in the face of incomplete, often contradictory information.
   
   That means redoubling my efforts in some areas—adding fiber, subtracting fats and carbs—and standing pat (or fine-tuning) in others: drinking rarely, making bacon and smoked turkey only occasional treats, and continuing to turn my nose up at anything that might contain stray hormones or soy, at least until the evidence says otherwise.
   
   I've still got more work to do—I'd like to meet with a nutritionist, for example—but I think I am off to a good start. After a whole month without fried, sugary, junk, or processed foods, I expected to spend November 1st indulging in all that I had given up. But now that I have some momentum behind me, I have to say that I'm not really even tempted.
   
   Yet.

Food, Inglorious Food - Part III

Note: This is the third post in this series. For background, read Part I first.

Back to my three simple reasons for trying to eat a healthy diet:

1. Maintain my weight. See Part II of this series.
   
   
2. Manage my cholesterol. This is a tough one because here I'm fighting not only my own food preferences (ice cream is my all-time favorite) but also a pretty daunting genetic bequest.
   
   My dad and many of my paternal cousins have high cholesterol or high triglycerides (basically a form of fat in the blood) or both, and an excess of either is not a happy thing. Problems with cholesterol and triglycerides are associated with heart disease, stroke, and diabetes, none of which I aspire to have.
   
   One of the drugs I take, Arimidex, can increase cholesterol, so between that and my genetic makeup, I'm already at a deficit before I sit down to breakfast, let alone dessert. And while there are blockbuster anti-cholesterol drugs out there, my personal pharmacy is already larger than I'd like, and I have no intention of adding to it without a fight.
   
   That means tackling the problem on my own.
   
   Although exercise also plays a role, the main way to combat high cholesterol and triglycerides is through diet: more fiber, less fat, fewer carbs (including sugar and alcohol). Since I was due for a physical and cholesterol check anyway, and because this is, after all, Breast Cancer Self-awareness Month, I tried a little experiment.
   
   For the entire month, I adopted an austerity diet: nothing fried, no sugar, no junk or processed foods.
   
   There's still one day to go, but I can already claim success. For one thing, I haven't slipped up at all despite the fact that this month has presented multiple challenges to my willpower: jury duty, a late night in the emergency room with my dad, a dinner party featuring Zach's homemade ginger cake with caramel-brandy sauce, walking past a brand-new ice-cream shop on an unaccountably warm October night, a backyard film screening complete with movie-candy classics (Milk Duds! Junior Mints!), and Halloween candy at every turn, not to mention the lesser temptations that come with being stressed and overworked in a city where unhealthy food beckons from every newsstand, bodega, and take-out place in sight.
   
   But even better than the satisfaction of making it through the month with my dietary chastity intact is the fact that the bloodwork from my mid-month physical was completely normal, down to and including my cholesterol and triglycerides.
   
   My diet still leaves a great deal to be desired: too few meals eaten at home, some recent backsliding on all the progress I'd made toward replacing simple carbs with whole-grain alternatives, not as many veggies as I'd like. And I have to figure out the exercise piece of the puzzle.
   
   But for the moment, my willpower and I have reason to celebrate.
   
   Care to join us in a sugar-free, non-alcoholic toast?

Food, Inglorious Food - Part II

Note: If you missed it, Part I of this post is here.

Laid out as simply as possible, here's what I'm trying to accomplish in eating as healthy a diet as I can:

1. Maintain my weight.


2. Manage my cholesterol.


3. Within reason, avoid anything that might somehow trigger a future breast cancer.

Because these goals get progressively more complex, I'm going to tackle just one per post. To begin:

1. Maintain my weight.
   
   Up until my second course of chemo last year, my weight had been stable since college. (This is the one positive side effect of being a picky eater, I guess—automatic calorie control.)
   
   It's common to lose or gain weight during chemo, and although I had no net gain (or loss) back in 2001, this time I added about 15 pounds.
   
   To compound things, I also have hypothyroidism, which makes it easy to gain (and harder to lose) weight.
   
   And having my ovaries taken out last summer plunged me into immediate menopause, which—bonus!—also makes it easy to gain weight.
   
   I've dropped 12 of those 15 new pounds, so I do feel mostly like my old self again, and lots of my old clothes are back in rotation, but I want to be sure not to backslide.
   
   In part that's because I just feel right at my typical weight.
   
   But it's also because staying at a healthy weight (aka avoiding obesity) is one of the few proactive things I can do to reduce my risk of a future breast cancer.
   
   Now, exercise is a big part of weight management, as well as another good breast-cancer-prevention strategy, but that's a whole other subject—to which you can bet I will return.

Ah, Youth

In reading today's installment of "Well" (Tara Parker-Pope's New York Times health blog), I came across a stat that shouldn't have surprised me but did:

The median age of cancer patients at diagnosis is 67.

I was 34 when I was diagnosed the first time, only halfway through what should have been the cancer-free part of my life—if you want to read the statistic in a very tortured way.

The median age is a bit lower for breast cancer: 61.

That still leaves me shortchanged by nearly three decades.

I've thought a lot about the difference between being diagnosed at a relatively young age versus later in life, mostly because so many people have given me a pitying look and told me how tragic my situation is. "You're so young!" they exclaim in disbelief.

I've always countered (although not always out loud) with the fact that being young works in my favor: I've had an easier time bouncing back from surgery and tolerating treatment than I imagine I would at twice my age.

That's still true, of course, but it's also true that some of those treatments have long-term side effects, not all of which are known, and that they may well cast a shadow down the road.

Hell, they've already cast a shadow—that's why I'm in the process of getting my heart checked out.

And that's why any children we have are going to be as much the product of technology as biology.

But perhaps putting my time in early means I will be blessed with golden years that are truly golden—long and healthy and full.

Even if we are still paying for college when our Social Security kicks in. . . .

Welcome, NYTimes.com Readers!

In today's expanded online version of her New York Times column, Shifting Careers, Marci Alboher linked to my recent post about breast cancer: the brand. (The main story is here and in today's print edition.) Marci does great work covering the revolution in career-making, and I'm honored to be mentioned in anything she writes.

So if you're taking a look around "Breach" at Marci's suggestion, welcome! It's always nice to have company, and I hope you'll visit often. My very first post, "Ground Rules," will give you some background, and the rest of the "Oldies but Goodies" links over there on the right will help catch you up.

And if you've been hanging around these parts for a while but haven't yet checked out Marci's blog, which is a companion to her column, click on over and see what you've been missing!

The Right Month for a Pink Slip, I Guess

Note to NYTimes.com readers: Please click here for a special welcome. Thanks!

I mentioned a few days ago that I'm in the market for two new doctors, one of which is a cardiologist.

The second isn't so much a new doctor as a replacement. And that's because after 17 years, I've decided to fire my internist.

When I started seeing him, he and his partner had a small, quirky, patient-friendly practice. They had funky art all over the place. They held monthly "salons"—discussions about politics, art, and current events. They were whip-smart but also funny and interesting.

They stressed preventive care—the reason I have annual physicals is because they got me into the habit. And they made life a little easier if you needed a routine Rx or a straightforward question answered—because they had lots of baseline information from your physical, you could call with minor issues or questions and have them addressed over the phone.

And they answered the phone. You'd call and ask for the doctor, and a minute or two later, you'd be talking to him. A few minutes after that, he (or his nurse) would call in a prescription to your pharmacy or tell you to come in that same day or give you the name of a very good specialist he knew personally.

During the physical, he'd talk to you about your life—what you did, where you were from, what you were interested in. He took notes by hand on plain white paper. He told you stories and established a rapport. He got to know you, and he remembered you from visit to visit.

As the years went on, the practice grew larger and larger. It was harder and harder to get through on the phone, even just to make an appointment. The waiting room got more and more crowded, and the care became less and less personal.

Still, I thought I was in good hands. I got what I needed from my doctor, harried though he might have been. And inertia worked its magic on me: the longer I continued as his patient, the less inclined I was to make a change. He knew me, I thought. He had a decade's worth of my medical records. Why should I start over with someone else—someone facing the same managed-care pressures as he was? I was healthy. I could afford some extra wait time on hold or in the waiting room.

And then suddenly I wasn't healthy.

All at once I needed a lot of medical care. And here's where that decade-plus relationship paid off. I got a great referral to my fantabulous surgeon. I got in right away for my pre-op physical. I got reassurance from someone I knew and trusted—and who happened to have trained at a brand-name cancer center.

My appreciation carried me a long way. And it allowed me to overlook some things that I would not have tolerated from a doctor I'd just met.

For one thing, Zach began seeing the same doctor—on my strong recommendation—many years before, and he'd had some negative experiences as the practice grew and became a more impersonal place. He talked for years about finding a new doctor, but I was never tempted to make the switch. I had too much invested in the relationship.

The initial fissure in that relationship came after my first breast-cancer diagnosis. For whatever reason, the doctor volunteered his opinion about my prospects for motherhood. It would be "suicide" for me to become pregnant, he said. The spike in hormones that would come with carrying a child would be "like laying a banquet" for the cancer to return.

He said all of this to Zach, who was in for an appointment of his own. I wasn't even there.

I was furious, but I let things lie. I was busy with other things—surgery and chemo, to be precise—and I didn't have the mental space to address what I felt was a serious lapse in judgment and protocol and respect. After the last of my treatment in late 2001, I continued to see the doctor for routine physicals, cholesterol checks, and the odd sinus infection. But most of my internal-medicine needs were handled by my-oh-so-wonderful-oncologist, whom I adored, and I didn't have much interaction with my internist.

Then I went off to grad school a couple of years ago, and suddenly my primary-care physician was the university's student-health service. Even if I'd wanted to see my internist, the school's insurance plan wouldn't have covered the visit. I was lucky enough to see a wonderful nurse-practitioner at the health service, and she became my go-to professional. Once diagnosis number two happened, of course, MOSWO was back in charge, so I was completely covered.

Now that I'm off the school's insurance plan and MOSWO has moved on, I gravitated back to my old routine and scheduled a physical with my internist. My appointment was last Wednesday.

I went in with a clear agenda: I needed a flu shot, I was overdue for a cholesterol check, and I wanted to talk about diet and nutrition and exercise. And, of course, I expected to have a complete once-over.

Things started off well enough. We sat in his office, and he pulled out a sheet of plain white paper and asked me what I'd been up to. I gave him the very abridged version: "I'm finishing grad school." He asked what I was studying, I said journalism, and then he said something like, "How soon before you become a blogger?"

I told him that I already had a blog and what it was about. For reasons I cannot fathom, he went on a long jag about suffering—how he was all for it if there was a purpose or benefit (i.e., a cure or a longer life) but completely opposed if it was in vain. Then he told me how strongly he favored euthanasia and that that's what he'd be doing if he had his druthers. He concluded by telling me that I should really write about suffering. Here.

I tried to explain that I write from my own experience, and that—so far, at least—that hasn't been my experience. This did not persuade him. Fortunately, he returned to the subject of the physical and started asking me for an updated family history. Did any of my relatives have cancer?

I gave him the history, which—aside from me, of course—runs mostly to great-uncles and first cousins, once removed. Among the exceptions—those more closely related—none had been diagnosed before age 75. It's true that one of my grandparents did have cancer (of a smoking-related kind), but not until age 95. The doctor sketched this all out in a family tree, then said, "Well, I guess you know what you're going to die of."

I must have blanched—wouldn't you?—because he said, by way of explanation, "There's no cancer in my family, so I know I'm going to die of heart disease."

Perhaps that was meant as a comfort.

It wasn't.

"There's heart disease in my family, too," I said.

It was at about this time—shortly after 8AM—that he pulled out a brownie from his desk drawer and began eating it.

"Don't you have a Ph.D. in nutrition?" I asked incredulously. (He does.)

He said something like, "That's what my wife keeps saying."

Then he told me that the brownie had come from a patient, which I suppose was intended to mollify me.

It didn't.

At that moment, "Talk about diet and nutrition" dropped off my agenda for the physical.

We moved from his office to the adjoining exam room, where he gave me the extended version of his elevator speech for the book he is currently writing. We had gone from conversation to monologue, and I mainly tuned out. Meanwhile, he gave me a flu shot and drew my blood for routine lab work. At least I had gotten the rest of my to-do list covered. I just needed to get through the rest of the exam.

I'm already getting seven clinical breast exams per year, so it's not like I needed another one. Still, if you're going to do it, do it right. His was a halfhearted effort, and he seemed to lose interest partway through. I have to wonder how diligently he would have done it if I hadn't already had breast cancer twice.

The physical ended with my slightly abnormal EKG. By then I was so disgusted that I didn't focus on the details of what he said, and for once I didn't have my notebook at the ready.

When I called the next day to get a clearer description of the problem, he must have thought I was obsessing about the results. (I wasn't.) I have to assume he was trying to reassure me when he said, flippantly, "You're not going to drop dead tonight."

He didn't.

I want very simple things from my doctors. They need to be excellent clinicians, and they need to know how to deal with people. Of the two criteria, you'd think that the first would be the tougher one. It always surprises me when physicians fall down on the second one.

In this case, "fall down" doesn't begin to cover it. "Plunge precipitously" seems far more apt.

But I guess I should be grateful that my soon-to-be-ex-doctor flunked the test so spectacularly, because it leaves me no doubt that I need to let him go. Any awkwardness I might feel about firing him after so many years is trumped by the memory of the careless, thoughtless, even callous things he said and did last week.

He's not a bad person. But he's no longer right for me.

As with any long-term relationship, it's hard to let go and move on. But I demand—and deserve—much better than this.

And I'm going to find it.

In the Market, Again

I have much more to say about food, but first this:

I suddenly find myself in need of two new doctors.

Here's why I need the first one:

Yesterday I had a physical, which includes an EKG.

Turns out mine was slightly abnormal.

Not wildly abnormal.

Not "here-put-this-little-nitroglycerin-tablet-under-your-tongue-while-we-call-911" abnormal.

But abnormal just the same, which means I need to see a cardiologist to make sure that nothing worrisome is going on. And while I have many different specialists on my medical team, a cardiologist is not yet part of my collection.

I've got a referral from the primary-care physician's office, but since it's of the "you-have-insurance-X-so-here's-the-name-of-doctor-Y" variety, I'm going to do my own legwork, thank you very much.

For one thing, I want the doctor to be familiar with the cardiac-related side effects of the various treatments I've had: chemo, radiation, and Herceptin.

The internist doesn't think whatever it is (if, in fact, "it" is something) has anything to do with my treatment, but I see no reason to take that on faith.

A lot of diligence is due here, and I'm not going to start stinting now.

Following Through

Well, it took me a week to finish, but I've finally scheduled all of the appointments I need to catch up on my routine medical visits.

Turns out that I haven't been to the endocrinologist in almost a year, which shocked me. It's possible that he doesn't need to see me as frequently as I had thought (3x/year is what I remembered), but I'm pretty sure it's supposed to be more than an annual visit. At the very least, the dosage on my medication needs to be checked more often than that.

I also remembered one other thing for my medical to-do list: a flu shot. It's not so much that I need one (as I did when I was going through treatment)—it's really to reduce the risk that I'll pass anything along to my dad, or be barred from visiting him for however long it would take me to recover if I did come down with the flu.

I'm having a full physical tomorrow morning, so I should be able to get one then.

Another needle—fun!

Food, Inglorious Food - Part I

Famous food stories from my childhood, plus one from my adulthood:

My mom (optimistically): "Jody, what do you want for lunch today?"
Me (completely put-upon): "Mom, I had lunch yesterday."

My parents took me to Montreal when I was about five years old. The whole time we were there (five days? a week?), I ate nothing but tomatoes and toast.

I once accepted an invitation to have dinner at a friend's house. I think I was in the first grade. Everything was fine until I was served a plate that included mashed potatoes. With gravy. I burst into tears and had to go home.

In high school, I dated a guy from a strict Catholic family. His grandmother lived with them and did all the cooking. Everything she made was delicious, but there were always things I would (politely) refuse to eat. She never understood that I was an exceptionally finicky eater. She just thought I was keeping kosher.

Early on in our relationship, Zach or I must have warned his mom that I was a picky eater. She asked me to give her a list of the foods I didn't like so that she could avoid them when we came to visit. "I'll give you a list of the foods I do like," I said. "It's shorter."

In my own defense, I am much less picky than I used to be. Just ask my mom or Zach if you don't believe me. Still, I am quite sure that any family member, friend, classmate, or co-worker asked to list my character traits would put "picky eater" at or near the top of the list.

And I accept that.

Because despite the fact that I have enlarged my culinary horizons far beyond tomatoes and toast—and even seek out a well made gravy for my Thanksgiving turkey (although usually not, I confess, for the mashed potatoes)—I now have other dietary limitations that threaten to overshadow all of my progress.

Life would be simpler, or at least more easily explicable, if I could summarize these limitations in a neat little label. People understand "vegetarian" or "vegan" (well, mostly) or "wheat-free."

They don't so much understand "Well, I'm a picky eater to begin with, plus I avoid meat and dairy products unless they're hormone-free, and I gave up caffeine in 1994, and I have to be careful with garlic and ginger and anything too acidic or I get heartburn, plus I need to watch my sugar, because I tend to have high triglycerides, and I shouldn't really drink because I'm on anti-inflammatories for the joint pain caused by having my ovaries removed last year."

You're just dying to invite me over for dinner now, aren't you?

And this is why I've waited until halfway through Breast Cancer Self-awareness Month to even raise the specter of diet—because it's a fraught subject for people who aren't picky eaters. (There's good reading about this here and here.) So where does that leave me?

Confounded, generally.

But I'm working on it.

More to follow in the rest of this multi-part post.

It's Not Just Me

Looks like I'm not the only one who takes exception to Breast Cancer: The Brand.

A few weeks ago, The New York Times launched a new health blog, "Well," by columnist Tara Parker-Pope. She recently put up a post called "Pick Your Pink Wisely," which addresses the fact that buying a pink-themed product this month may provide a lot less bang for your breast-cancer buck.

The post and accompanying comments are worthy of a read, and the links they contain merit a click. I'm also putting those links (corrected in one case) here, so that they're within easy reach:

• Breast Cancer Action's "Think Before You Pink," which outlines concerns about cause-related marketing in the world of breast cancer.


• BCA's list of six questions to ask before you buy a pink-beribboned product.


• Barbara Ehrenreich's landmark essay, "Welcome to Cancerland," originally published in Harper's in 2001 and reprinted on her website.

I'd heard about Ehrenreich's essay but didn't get to read it until now. I wish I'd known her back in 2001. I think we would have had a lot to talk about. Actually, I'm sure we still have a lot to talk about.

My Medical Dance Card

In keeping with my pledge to spend this month reviewing my own personal cancer-prevention protocol, as well as other healthy-living efforts, I thought I'd start with a roundup of all the tests and check-ups I'm supposed to have.

Make that the routine tests and check-ups I'm supposed to have—this gargantuan list is actually shorter than it would be if I were still in active treatment.

Here goes:

Appointment With	For	Frequency	Status
Yours Truly	Breast Self-exam	1x/month	Done this month, but somewhat iffy overall
Rheumatologist	Check-up	4x/year	✔ (3 down, 4th already scheduled)
Oncologist	Check-up*	3x/year	2 down, need to schedule 3rd
Endocrinologist	Check-up	3x/year	Overdue—need to schedule
Gynecologist	Check-up (clinical breast exam et al.)	2x/year	✔
Breast Surgeon	Check-up*	2x/year	Overdue—need to schedule
Dentist	Check-up	2x/year	Due next month—need to schedule
Internist	Physical	1x/year	Scheduled for this month
Radiologist	Mammogram & Breast Sonogram	1x/year	✔
Radiologist	Breast MRI	1x/year (6 months after mammogram)	Due in February—need to schedule
Dermatologist	Skin-cancer Screening	1x/year	Overdue—scheduled for this month
Radiologist	Bone-density Test	1x/year	Overdue—need to schedule
Ophthalmologist	Check-up	1x/year	Overdue—need to schedule
Internist (and Digestive Disease Subspecialist)	Colonoscopy	Every 5 years	Scheduled for October

*plus extra clinical breast exam

Well, I'm chagrined to have so few check marks in the right-hand column—I'm typically more on top of things. Looks like I have a bunch of phone calls to make this week to set up a(nother) whole slew of appointments.

And there's no excuse for me not to be doing my breast self-exams each and every month. The only salvation there is that I have at least seven clinical breast exams each year—way more than the recommended minimum of one—so I never go too long without a thorough once-over. I do think that the calendar approach will solve the problem—it's worked for me in the past.

This brings me to a question I've often pondered: why don't people do things that are demonstrably beneficial? In my case, doing a breast self-exam led me—indirectly, but still—to detect a new and completely unexpected cancer. Finding it myself meant catching it—and eradicating it—that much sooner. So how could I ever again let a single month go by without checking myself out?

The flip side of the phenomenon, of course, is when people persist in doing things that are demonstrably harmful. Case in point: why does anyone still smoke? How can one possibly justify the act of lighting up a cigarette, inhaling, and then blowing toxic waste into the air?

If we're wired for self-preservation, how do we explain this kind of behavior? How do we reconcile it with our fierce, innate will to live?

Big D

Welcome back to Breast Cancer Self-awareness Month.

It dawned on me today that in dealing with breast cancer, you're either on offense or defense. That is, you're either aggressively fighting the disease once it's struck, or you're digging your heels in and doing everything you can to keep it at bay.

I've been on both sides, and I have to say that offense is easier.

Not better.

Not preferable.

But easier.

It's in our nature to fight back when we're attacked. We close ranks, marshal our resources, and start firing whatever we've got at the enemy.

With breast cancer, what we've got is surgery and radiation and chemotherapy and targeted drugs. Sometimes we need only one. Sometimes we lob everything we can and hope we don't run out of ammo. But whichever weapons we deploy, we do it in a heightened state: the adrenaline has kicked in, and it keeps us focused on the mission at hand, and that keeps us moving forward.

By contrast, the periods before and after cancer are quiet. We do everything we can to prevent the enemy from sneaking up on us, but it's like standing watch or riding patrol: there's no underlying sense of urgency, and therefore it's easy to slack off. Every day without an incursion seduces us just a bit more, makes us comfortable with the status quo, and convinces us that the danger has passed.

It hasn't.

And that's the problem with playing defense. We're basically waiting for cancer to make a move so we can react. And even though there are many proactive things we can do—under the rubrics of prevention and screening—it's just a much more passive posture. And that makes it hard to rally a lot of energy for the prevention and screening we need to do.

Cancer has many shortcomings. But you can't say that the specter of active disease fails to motivate.

My challenge this month is to find a way to play defense as doggedly and aggressively as I've played offense, and to combat the Big C with the biggest D I can muster.

And even though you can't typically put up points on defense, I'm going to find a way to keep score.

Breast Cancer Self-awareness Month

I vividly remember walking through a Barnes & Noble bookstore back in April 2001, not long after my first diagnosis and surgery, when I was still digesting the news that, contrary to earlier predictions, I was going to have to go through chemo.

As I rounded a corner on the second floor of the store, heading for the down escalator, I practically walked into a display table full of books under a sign that said, "April Is Cancer Awareness Month."

It felt like a scene out of a sitcom.

A bad sitcom.

I've never seen a sign like that again, or heard anything about April being a big cancer month, but the perversity of the situation made a big impression on me. I don't think I could have been more aware of cancer if it had been growing inside me. Which, of course, it had been. (Bad sitcom, remember?)

Fast-forward six and a half years, and I'm still put off by the whole "October is Breast Cancer Awareness Month" juggernaut. But I realized the other day that I could choose to view it entirely differently.

Instead of (or, more accurately, in addition to) griping about how marketing has invaded health care, I could interpret "Awareness" as self-awareness.

I could choose to make October my annual check-in—a time to take stock of everything I'm already doing to prevent and detect cancer and then compare it to the latest thinking on what I should be doing.

What am I missing, or forgetting, or being lazy about?

What appointments do I need to make?

What tests do I need to have?

And what insurance claims do I need to file or follow up on?

Beyond all of that, what can I do to help others get through this odyssey? Make a donation? Give a speech? Write a letter? Offer advice to newly diagnosed patients? All of the above?

Lots to think about.

Details to follow.

Save the Dates

Happy October, everyone.

Although I am not at all over my pique at the branding of breast cancer, I do recognize the opportunity that this designated month offers, and I'm going to try to make the most of it.

For starters:

Ladies, please stop reading this post and do three things. First, take out your calendar and make a monthly date for breast self-exams. If you're not sure when or how to do them, click here.

I'm not kidding about this. Don't think you'll just remember to do a BSE each month. Actually put it in your calendar. If I need a reminder to do life-saving BSEs, then it's a pretty good bet that you do, too.

Second, if you haven't seen your gynecologist in 2007, pull out your to-do list and write "make appointment with gynecologist." You need to have a clinical breast exam at least once a year with someone who does lots and lots of clinical breast exams. If you don't currently have a gynecologist, FIND ONE NOW. If you've already had your clinical breast exam this year (nice work!), flip ahead to 2008 and write yourself a reminder to schedule next year's exam.

Third, if you are supposed to have a mammogram this year but haven't already done so, add that to your to-do list. If you're not sure whether you're supposed to have a mammogram, click here or ask your doctor. And if you've already had one this year (hooray!), get a head start for 2008: put "schedule mammogram" on your calendar 6-8 weeks before the anniversary of this year's exam.

Gentlemen, please ask the women you love to do the same.

I don't like to nag, but I make a big exception when it comes to breast cancer.

So this is me nagging.

OK?