Ah, to be young again...

I turned 40 on November 9th of last year, 2014. Although I occasionally get nostalgic about my younger years, I'm mostly happily settled into 'middle age.' I have an awesome family with two kids (I always wanted two, but the second one was never a given), a good financial situation, a good job (despite my complaints), and a really lovely group of friends. A lot of my friends, most of whom have kids the same age as my daughter (who is going into 4th grade), are older than I am, and have said that the 40s are their favorite decade so far. I can feel that. I love life. The 40s are good.

Minus the cancer.

And come to think of it, even with the cancer, I still have an awesome family with two kids, a good financial situation, a good job, and a really lovely group of friends. So the 40s are good. I just hope I live long enough to compare the 40s to the 50s and the 60s and the 70s and the 80s.

So you think I'm being morbid and melodramatic, do you? Well, not so much it turns out.

2014 was filled with a lot of stress over my hip situation. I felt like 39 was too young to be having such severe hip pain, and that I could not live with the pain for the rest of my life. So I had hip surgery, which led to DVT. Hobbling around and taking Xarelto definitely makes you feel older than 39 or 40. These are an old person's problems. I wanted to feel young, or at least 40 years old, and not 70.

Now I have cancer. Talk about an old person's problem. In Cancer Land, I am young. In some studies, I even qualify as Very Young. All three oncologists I saw mentioned this, but I never fully got it. After all, I am not Very Young! I am middle-aged, and happily so!

But now... I understand. It all started with a discussion on breastcancer.org centered around a 31-year-old reporting that her oncologist had told her she needed to double her risk factor because of her age, and her age alone. She recommended chemo despite the fact that that this woman is early stage with a non-aggressive, hormone-positive breast cancer. Some people were disbelieving of age as an independent factor in risk, and indeed, there is a school of thought that the only reason young people with breast cancer have a worse prognosis than old people with breast cancer is because young patients tend to find the cancer themselves ( = larger tumors and later stage) and the incidences of triple negative cancer ( = harder to treat) are higher. But there is also a school of thought that the cancer itself is different when you are younger; it is more aggressive for reasons we don't yet understand. Age by itself is an independent prognostic factor for risk of recurrence and metastasis. All of the oncologists I saw seemed to belong to this school and told me I needed to add 'one degree of severity' to my diagnosis because of my age. I kind of shrugged it off at the time, reveling in my relief that I was early stage with a treatable type of cancer.

Of course I reacted to this conversation in typical science-y fashion by doing a PubMed search. And apparently, you can argue it both ways. There are studies to support both schools of thought. But the data that support the idea that age alone is a risk factor are fairly depressing. Those 90% cure rates you hear about? Not applicable to younger people. And even at 40, I am considered 'young' in all studies, and even 'very young' in others. I'm still picking through piles of articles, and there are loads of complicating factors in all of this, but I now understand the full gravity of what oncologists have been telling me. Cancer at 40 is different than cancer at 60, for whatever reason. I may want to consider being more aggressive. I didn't really pay attention to this because it was too hard for me to wrap my mind around having my ovaries taken out, and according to stats, I should have around a 10% chance of recurrence without putting myself through that hell. But those are stats based on old ladies, who often die of something else before the cancer comes back or at least before it comes back enough to kill them. People try to tell me that data lie, and you can interpret data however you want to come to the conclusion you want to see, but this goes against everything I believe as a scientist. Data are data. Data give us live-saving treatments. Even if the data are not conclusive, they are at the very least eye-opening. And trust me, my eyes are now wide fucking open. And they don't like what they see.

It just goes to show that you should be careful what you wish for. I wanted to feel young again, and boy, do I ever.