My ex has been in the news this week, showing up in journal articles and editorials. My ex is named Statistics, and our on-again, off-again relationship is still a little raw. We used to be together, and we sometimes still see each other socially and professionally. In Facebook parlance, “It’s complicated.”
We met at my job as an ICU nurse, where I used Statistics in my work to both educate and comfort my patients, and also because I thought Statistics made me sound smarter. It is also true that Statistics and I had a personal relationship outside of work, which is why I drove carefully nearest my home, did not bother to play the lottery, and brought Statistics with me to that first mammogram, so that I would not be nervous.
And then, as you know, I drew several short and unlikely straws: having cancer at all, having a hidden invasive cancer, and that having that invasive cancer be the kind that makes oncologists nervous. The hardest losses, though, were the long term ones, like the lifetime risk of recurrence which was a percentage of some debate, but which would not earn you an A (and perhaps not even a B in private school). And the residual risk following treatment, which could be reduced, but which could not be eliminated. Statistics had betrayed me for the last time, and it was time to break up for good.
Post-breakup, things became simpler. Unburdened by data, I saw my chances as 100 percent, or zero; I was either going to live or I wasn’t, and with equal parts determination and abject terror, I chose therapies that were at the very least aggressive, and quite possibly excessive. Now on the other side of healing and with a more balanced appreciation of risk-benefit ratios, I can admit that about my choices. Which is not the same as saying that I regret them.
I have started having coffee with Statistics again. After all, things have been better recently, and perhaps a cautious trust is in order. Even if I could live without Statistics in my personal life, I am once again in need of Statistics to educate and comfort my patients in my work.
There were several headlines that, quoting Statistics, piqued my interest this week, including ones reporting new data on the risks over benefits of screening mammography, the overuse of prophylactic mastectomy in certain populations, and, less prominently, the apparent willingness of women with dense breasts to take on the biopsies and false-positives that come with increased screening. Woven through all of these is a new realization of a very old reality: even today, the best time in the history of the world to be diagnosed with breast cancer, women remain afraid.
Statistics won’t tell you this, but survivors will: the fear of breast cancer, and perhaps even more so of breast cancer recurrence, cannot be quantified. Unfortunately, the long and sordid history of breast cancer has left behind an uneasy dread that cannot be powered for statistical significance. It is better than it was; I remember the days breast cancer was not discussed, and I am ever grateful for the strides we are making. But we are missing the point if we look at data on what women want to know when, and why women make the decisions they do, as only about Statistics. Statistics are only part of the survival story. It’s complicated.