Friday, May 4, 2012

Adam Yauch, Warren Buffett, and the Big C

"Dip, dip, up your ears and clean out your eyes/If you learn to love you're in for a could be nice to be alive."  -- Beastie Boys, Alive

This week, two people who have had fairly substantial impacts on my life -- albeit in very different ways and for very different reasons -- were in the headlines because of cancer.

Warren Buffett was diagnosed with prostate cancer and Adam Yauch is dead because of salivary gland cancer.  Some basic research shows that those are two VERY different things.  For local prostate cancers, the five-year relative survival rate (relative rates factor in that people may die of other causes), is very close to 100%.  It's not mathematically 100%, so it's not listed that way, but it's just about there.

For salivary gland cancer, not so much.  It's extremely rarer, so the statistics are harder to parse out, but it is a significantly lower number (though nowhere near as low as many other types).

I feel like that's important to point out.  Even though heart disease kills more Americans each year, it doesn't have the chill-up-your-spine power that the word 'cancer' does when it follows a pronoun and the word 'have.'  But the fine point is that there are at least 200 different types of said disease, and they all mean different things.

When I heard "Adam Yauch died from cancer," I instantly wanted to know more about what happened.  I saw that he had salivary gland cancer (a type of head and neck cancer) so kept reading and trying to dig more and more into the medical side.   Reading some of the comments about Adam Yauch in which people speculated about "lifestyle choices," I got a bit emotional.  No one really understands what causes cancer.  You could cram all the M.D./Ph.D. oncologists in the world into a room (or even into the 7th Floor of the Yawkey Center) and they would NOT agree with each other on the subject of carcinogenesis.

There are risk factors.  There are the well-known ones, like cigarette smoking and exposure to chemicals.  Some are sometimes viral (i.e. cervical and some oral variants).  There are even studies suggesting that alcohol intolerance is a risk factor for squamous cell carcinoma.

There are many millions of cancer survivors all across the U.S.  It's almost certain that you know several of them.  To each of them, the treatment and recovery experience is totally different.  It could literally be a single trip to the doctor's office, some anesthesia, and not much more.  It could mean a prostate comes out and a bit of radiation.  Towards the other end of the scale, it could mean months or years of painful, debilitating chemotherapy.  It can mean an entire loss of an organ, or maybe some high-tech surgery that makes new body parts out of old ones.  Some people are lucky enough to have great health insurance.  For others, cancer could mean the very real fear of bankruptcy or homelessness.

Because the experiences are so varied, and personalities are so varied, there are endless permutations to the way people might deal with it.  Someone might write something funny (Seth Rogen's buddy that wrote that screenplay), someone might make a TV special (Tom Green), someone else might wear a yellow bracelet, not wear a bracelet, participate in a walk, choose not to participate because of a Memorial Day event, quietly send checks to Dana Farber, or just walk away and try to never think about it.

So there's no right way to respond to a friend or relative that confides in you that he or she is about to go under the knife, or the poison, or that he or she survived said experience in the past.  Broadly speaking, there's not much of a *wrong* way, either.

But there is one thing that you should never say in that situation.  You should never take on an accusatory tone and demand of the person, "What did YOU do to get that?"  I don't mean honest curiosity -- that's natural, and people should have it, out of concern for their own health.  What I mean is a statement or a question with a tone that makes the person feel like a pariah, with either an insinuation or outright implication that he or she has done something wrong, is somehow contagious, or somehow, by some action, deserves to be victimized by renegade cell division.

Nearly all people, or nearly all adult people, at least, don't need to be told that.  But much like the person in Baltimore who influenced Countee Cullen to write the poem "Incident," those other people are sometimes easier to remember.

All the Ph.D.s in the world will never be able to definitively, precisely tell you why Adam Yauch got cancer in a salivary gland.  Nor will they be able to do that for anyone else.  To think otherwise is to confuse the definitions of "puzzle" and "mystery."  The Big C is the latter.  Always.