Picking the "Best" Cancer

Suzy walked into a boutique called “Cancers R Us” in the high end of town.  It’s located between the Coffman Tobacco Wholesaler and the Sizzler Tanning Salon.  An associate greeted her at the well-polished counter with a friendly, “May I help you?”

“Yes,” replied Suzy.  “I’ve been diagnosed with cancer and I’m here to pick out which type.”

“I see.  Well, first of all, I’m sorry for your diagnosis, but I’m here to help you select the cancer that works best for you.  Are you interested in a more highly exclusive cancer, or one more common?”

“What’s the difference?”

The associate goes on to explain, “The higher the exclusivity, the higher death rate and suffering.  However, if you survive, you’ll be in a very elite group.”

Suzy started to respond when another woman entered the boutique.  She was dressed in purple and looked frail with hardly a hair on her head.  The associate looked her way and said, “Hello Margaret, I’ll be right with you!”

Suzy asked the associate why Margaret looked so frail.  “Oh, she purchased one of our more exclusive cancers…pancreatic cancer.  Their color is purple…that outfit was part of her cancer kit.  She’s come in for a Stage upgrade today.”

“Oh my…she doesn’t look well at all.”

“That happens with such cancers, but if she survives, she’ll be in the most exclusive cancer club!”

Suzy’s expression became slightly glazed.  “Um, maybe I don’t want something quite as exclusive.  Do you have anything a little more common?”

The associate smiled and said, “Well, one of our more common cancers for women is breast cancer.  Let me show you the package.”  The associate places a pretty pink box on the counter and opens it to reveal a pink shirt and several pamphlets.  “As you can see, breast cancer also has some level of exclusivity, but because of its popularity, there are more funds provided towards research.  This results in a better mortality rate and thus a less exclusive status.  But it’s widely popular as many people participate in walks and events and it even has its own month!”

“Wow!  That sounds better than that other cancer!”

Margaret was listening and chimed in, “I wish I had chosen breast cancer.  It’s nice to have the potential to be exclusive, but it’s so hard.  I have to fight almost alone…there are very few walks or events.  And while there is a month devoted to my cancer, no one knows about it.”

Suzy added, “Well, I guess it’s not a bad choice to make if I HAVE to choose one.  My friends at the Sizzler were mentioning something about a pink walk...it sounded fun.”

Margaret responded, “Oh honey…there might be walks and events, but there’s nothing fun about it.  The walks are important in order to survive!”

“Wait…so people still die from breast cancer?”

“Every day.”

As a silence set in, the associate asked, “Did I hear you say something about the Sizzler?”

Suzy responded, “Um…yes.  I go to the Sizzler twice a week.”

“Oh, well you might be interested in a cancer from our skin series.  By being a Sizzler client, you are eligible for a cancer upgrade!”

Suzy looked at the information and asked, “What’s this male-a-normal?”

“That’s melanoma.  It’s increasing in popularity and has a very high exclusivity rating as well.  Their color is a chic black.”

“Um…I think I want to stick with the more common variety.  Besides, black is a little warm in the summer months as I work on my tan.”

The associate added, “Well, this is our most common of all cancers but really can’t be considered exclusive at all.  It’s called Basal Cell Carcinoma and hardly anyone ever dies.  Their color is orange…sometimes black.”

Suzy’s eyes lit up.  “Oh yes…definitely!  I want basal cell carcinoma!  Does my Sizzler upgrade still apply?”

“Yes it does…just sign this form and I’ll be back with the kit.”

As Suzy signed the form, the associate returned with a tape measure.  “Here, let me measure your ear.”

“Um…why are you measuring my ear?”

“It has to come off.  Basal cell carcinomas are cut out with surgery.  Most are on the back or legs or head, but some occur in other areas.  With your upgrade, you’ll be more affected. In this kit, your ear will have to be removed.  But don’t worry hon, we’ll give you a prosthetic ear that looks almost normal.”

“WHAT?  My ear!  I thought no one got hurt with this cancer”

“Oh sweetie…I said very few people die.  But everyone with cancer suffers in their own way.”

Kind of a sick little story, eh?  Let me start off by saying that I meant no disrespect to anyone with any type of cancer. The story above was inspired by a recent Facebook discussion over an ad by Pancreatic Cancer Action, a charitable organization in the UK.   The ad shows a young woman with pancreatic cancer and a headline stating, “I wish I had breast cancer.” 

While the headline is shocking and offensive to many, I think most people “get it.”  Breast cancer has a much higher survival rate where as a pancreatic cancer diagnosis is akin to a death sentence.  I think the true message this girl is trying to say is “I wish I had breast cancer instead of pancreatic cancer.”  After all, no one…I mean NO ONE wants ANY cancer.

The debate that evolved in the discussion was whether one cancer was “better to have than another.”   I’ve heard the same discussion within the melanoma community regarding Stage 0 thru Stage IV.  You see, most early stage melanoma patients have a 97% or higher survival rate.  The cancer can be cut out and it’s essentially “gone” (although we all know that melanoma has a 1 in 3 chance of recurring, so it’s never truly “gone”).  Those diagnosed with Stage IV melanoma have around a 10% survival rate.  There’s obviously a big difference between the two, and that gap has prompted people to argue over the definition of “survivor” or whether or not the two extremes should even be considered the same cancer.

It’s obvious that the Stage IV patient suffers much more, especially physically.  The same can be said for someone diagnosed with pancreatic cancer over basal cell carcinoma.  But the mental anguish can run deep, even with the shallowest of physical scars.  Cancer affects every patient differently, but it DOES affect every patient.

Several years ago, I was told I “might” have prostate cancer and I endured two biopsies to find out I did not.  I was told that I had a high probability of developing the cancer in my 50’s. I’m 51.  I have thought of that “probability” every day since turning 50. The thing is, I was told that prostate cancer was “a good one to have” because most men with prostate cancer die of something else…it’s not the prostate cancer that kills.  Yet, I have a friend whose father died last year…from prostate cancer.  It was a death as gruesome as anyone with pancreatic cancer or breast cancer or melanoma.  Knowing that has affected me.  And that was just a cancer probability, not a diagnosis!

My point in all this is that no one wants cancer.  Ali Stunt, the founder of the aforementioned charity stated the same thing.  The ad was more about the imbalance between research performed and grants donated.  I can understand her frustration.  At the same time, I don’t envy any cancer and I think the headline could have been a little more sensitive.  We might have pink envy, but I can’t imagine anyone at all “wanting” any type of cancer.  At all.

Whoops...

Last night I posted a blog called “When Should a Child Start Seeing a Dermatologist to Check for Skin Cancer?”  I suggested that one should “examine your child for the same suspicious moles and spots that you would an adult.”

A sharp-eyed fellow melanoma advocate was kind enough to tell me that I was wrong.  (cough cough Rev Carol cough cough)  She eluded, “Pediatric melanoma is very different from adult melanoma and usually presents itself differently, too.”

I stand corrected and slightly embarrassed.  I usually research or at least reference my sources for medical statistics, especially considering that I’m not in the medical field (note disclaimer to the left!)  However, in this case, I made a general assumption that melanoma on children would be the same as that on adults.  I was mistaken.

The rest of my blog post still stands on its own…take your kids in to the dermatologist especially if there is family history of melanoma or if there is an unusual or suspicious spot.  However, as I learned, the criteria for that suspicious spot could very well be much different than a spot or melanoma on your own body.

Pediatric Melanoma will be the subject of a blog post very soon…as soon as I do the necessary research!

When Should a Child Start Seeing A Dermatologist to Check for Skin Cancer?

At what age should a child start seeing a dermatologist for full skin checks? 

I asked this question from my Twitter as well as on my Facebook page.  My kids are 11 years old now and about ready to make the transition from pediatricians to general practitioners and/or specialists, including dermatologists.  But is it too early to take the kids in for a full body check?

As I posed the question, my engineering logic was expecting a specific answer like “8” or “12.”  However, most answers were far more emotional than logical.  A large number of the respondents stated that they took their children to have their skin checked as soon as they themselves had been diagnosed with melanoma.  This stands to reason.  Even as an adult, I didn’t start visiting the dermatologist until my brother was diagnosed.  Many times, it takes a big ol’ slap from the black cancer upon a loved one to take notice.

But it’s not just that slap in the face.  Family history is one of the key uncontrollable risk factors toward a melanoma diagnosis.  Did you know that if two immediate family members (parent, child or sibling) have melanoma, you have a darned good (bad) chance of being diagnosed with it as well? [source]  So by all means, if there is any…ANY family history of melanoma, one should have their children checked.

Another criteria as to whether to have the kids checked is to perform the check yourself.  Examine your child for the same suspicious moles and spots that you would on an adult.  Use the ABCDE method and check for Asymmetry, Border irregularity, Color difference or changes, Diameter greater than that of a pencil eraser, and Evolving or changing moles.  If any of these conditions exist on the child, see the dermatologist.

When I was a kid, I was covered in moles.  I still am.  I played in the sun and became a pool rat in my teens.  I’m probably lucky to have had only an actinic keratosis cut away from my body.  My kids have few if any moles.  They have grown up in a time (and in a family) when applying sunscreen is the norm.  Melanoma is extremely rare in kids under 12, but like a contact at the Melanoma Education Foundation told me, “there is always that first and rare case and I’d rather be a little over protective and overly cautious than be that 1 in a billion  statistic.”  I agree.

My children’s pediatrician has always been diligent about checking their skin along with everything else, so we’ve been very fortunate in that respect.  My kids have an appointment to see him again within the next couple months for their annual checkup.  At that time, I’ll ask him what he thinks is the best age to start seeing a dermatologist.  I suspect he’ll tell me the same as I learned from you.  If there is a family history, a suspicious spot, or excessive sun exposure, start taking your kids as soon as possible.  And make an appointment for yourself as well.  It’s never too early to have your kids checked…and it’s never too late to get yours checked.

What You Can Do in the New Year

We have a new year before us…one in which we can take action to further melanoma awareness and fund-raising.  Here are a few ideas on how you can make a difference in the coming year!

• Donate money.  Okay, times are tight.  I know this much more than I can admit.  But it’s not that hard to save a little on the side to give to melanoma research or any charity for that matter.  Believe me when I say that every dollar counts, and if you can only give one dollar the entire year, it still counts!  For me, I plan to save a little (really…a little is all I can afford at the moment) every month to go towards charitable donations.  Most of it will go to melanoma awareness and research.  Some of it will go to other charities that are dear to me.  I will by no means be a high-level donor, but I will donate something.  You can, too!  One dollar or one hundred dollars, the MRF, AIM and so many other organizations appreciate every penny.

• Participate in a walk.  I’ve been to four melanoma-related walks in the last three years and each one proved to be an emotionally rewarding experience.  You’d be surprised how easy it is to get people to help donate to your efforts.  Even if you don’t raise a ton of money, just participating and being around others who “get it” will forever impact your life.

• Reach out.  Within the online community, there are many people affected by melanoma in one way or another.  Simply sending an email, text of Facebook message that says, “I’m thinking about you today” can make that person’s day.  We all need that support, and offering even a little here and there will pay back more than you can imagine.

• Set an example.  Practice what so many of us preach and wear your sunscreen.  Wear a hat (preferably a wide-brimmed hat) especially on sunny days.  Wear your sunglasses.  Stay in the shade.  Stay away from tanning beds!  If you have kids in your life, your example will set their good habits in the future. 

• Get checked.  You should examine your own body at least once a month.  Use a hand-held mirror to check every inch of your body.  Click here on how to perform a self-exam.  Go see your dermatologist at least once per year for a full body check.  To help remember, schedule an appointment near your birthday to have your birthday suit check.  This should be in addition to any annual check-ups with your general practitioner.

It’s easy to make a difference.  It doesn’t take a Herculean effort…just a small gesture here and there, a penny or two, and a caring heart.  You'll have a better new year for helping!

 

Happy New Year everyone from Black is the New Pink - Fight Melanoma!

What I learned in 2013

Usually I try to make resolutions for the coming year.  I always falter.  Case in point, last year I documented that I had hoped to lose 15 pounds in 2012 and yet I gained 8.  I repeated the same resolution for 2013, and yet I’ve gained 5 more pounds.  Clearly, I’ve learned that I’m not the best at keeping my resolutions.  But I have learned other things in 2013.

·        Elected officials are not the most intelligent people in the world…or the nation…or the state.  You would think that we’d elect the brightest of our peers (no matter the political party) to represent us when it comes to establishing the laws of the land.  But when I listened into the teen tanning debate over the North Carolina Legislative podcast, I felt like I was listening to a high school pep club arguing over which brand of tissue should cover the homecoming float.  Many of the arguments were based on hearsay and not on any real factual evidence.  Those who had no medical knowledge declared the health benefits of tanning beds.  And even some who supported the ban seemed to be a little loose on their facts.  I learned that public policy is based solely on gut feel and peer pressure and very little on fact and the common good.

·        Politics can be…well, political.  After the teen tanning ban bill died in committee, I was convinced we had lost a major battle.  In fact, I learned that the bill’s status in limbo was expected by those who introduced the legislation.  Apparently, this first run was to expose the strengths and weaknesses in the tanning ban legislation and to determine who would be the strongest allies and staunchest adversaries.  Having had the expected results of the first run, I’m sure the next run at banning teen tanning in North Carolina will be met with better success.

·        I can have a voice, even if I fall flat on my face the first time.  I was given the opportunity to tell Jeff’s story at the Miles for Melanoma Raleigh walk in October (also known as the Amanda Wall – Corey Hadden Memorial Walk).  I hate public speaking.  I mean, I really hate it.  But I really wanted to tell Jeff’s story despite my fears.  A couple of weeks prior, I had the opportunity to speak at a West Virginia University Alumni gathering to announce the upcoming walk.  I attempted to give a much abbreviated version of my speech and I froze.  I mumbled a few words and somehow squeaked out the time and date of the walk, but that was it.  So when the day of the real speech arrived, I was a nervous wreck.  I had practiced in my head many times over, but I was still nervous.  And yet when the time came, I felt as if I were in a trance…in “the zone.”  I nailed the speech and said exactly what I wanted to say with the passion in which it intended to be conveyed.  Fall seven times, stand up eight.

·        People can be very giving.  I already knew this of the melanoma community, but I have been reminded over and over throughout the year.  When it comes to donating to melanoma awareness and fund-raising, those within the community are more than willing to give.  The aforementioned Miles for Melanoma Raleigh Walk raised a record amount.  At the same time, when someone in need of support asks for such on my Facebook page, others in the melanoma community flock to assist.  It’s an amazing thing to witness and one of the main joys of keeping the BITNP Facebook page going.  It’s helping other people.

·        Melanoma awareness is increasing.  There has been more press about the dangers of tanning and the importance of getting your skin checked.  Articles and videos have popped up on television station websites.    Great PSAs are also appearing from larger organizations…with the latest from the American Cancer Society making a statement that “tanning is really bad.”  People ARE becoming aware.

I’ve learned these things and much more.  I’m excited about 2014.  While I won’t make any resolutions, I do have one hope.  While I hope that melanoma awareness continues to rise, my real hope is that real KNOWLEDGE about melanoma and skin cancer will spread.  It’s not enough to just be aware, it’s about being knowledgeable.

Happy New Year everyone!

Secrets

Image: washingtonpost.com

The holiday season is a time for many things.  Family.  Friends.  Worship.  And secrets.  Everyone in my family has at least one secret during the holidays, mostly involving gifts.  My kids are both now in Middle School and they have become quite talented at keeping secrets.  Each of them picked out presents for other family members by themselves this year.  Each also have neither confirmed nor denied the existence of a certain North Pole resident.  I imagine they suspect that Santa is not a real person, but they’re keeping that opinion to themselves.  My guess is that if they announce a disbelief in Saint Nick, they believe the presents will cease to appear on Christmas morning.  At least that was my thought at the same age.  Regardless, they are both keeping this a secret from me.

Another secret was revealed to me over these last two weeks.  My ever-developing and maturing 11-year old daughter who has always adored me as a hero now has a boyfriend.  It’s just a class-mate crush, but I’m aware that such “relationships” are more complicated in this day of texting and emailing.  I don’t have a fear of my daughter having a boyfriend…just of the modern day etiquette and practices of which I’m not aware.  She finally asked my wife to share the news with me, so I approached my daughter with a smiling and understanding expression and told her I wouldn’t tease her (much) and that it was okay to have a boyfriend.  I also told her a father’s job is not to tease the daughter, but to intimidate the boyfriend, so I’d look forward to that day soon.

It was my son who surprised me the most.  He knew of his sister’s boyfriend (who happens to be one of my son’s best friends…another dynamic that should prove to be challenging down the road).  What surprised me is that he could keep a secret at all.  He’s the one that often blurts out the most untimely comments in public (think “Fire! in a crowded movie house”).  He’s always the one that crumbles under the “Daddy stare” into a fit of giggles and cries of “Okay okay…I’ll tell you!”  But within Boyfriend-Gate, he showed no signs of having knowledge at all.  I would be proud of him if it wasn’t for the worry this has set upon me.  These are the first secrets of many to come.  Many, many!

Don’t get me wrong, I have fantastic kids.  Sure, I have parental bias, but I think I speak fact as well.  They both do well in school and each has a good set of friends that also perform well in class as well as in social groups.  My kids could be more active, but their lack of involvement is as much my fault as anyone’s.  Overall, they are really good kids.  Good kids that have learned to keep secrets really well.

I predict (hope) that they will make good decisions in the future.  They know that smoking is bad (it killed their grandma) and that tanning is bad (it contributed to their uncle’s death).  But I know they’ll do things and try things of which they’ll keep secrets.  I know this because I did.  I have secrets that I would never tell my parents and that I’ll probably take to my grave.  I did things that I knew “was wrong” and yet I did them anyway.  I’ve made better and smarter decisions later in life and would most likely not repeat some of those earlier actions.  Those actions…which started when I was just slightly older than what my kids are now.  So yeah, I have to be realistic and know that my kids will make some poor decisions.  Despite being incredibly well behaved kids now, they’ll make the occasional bone-headed decision.  And they’ll keep some so secret that they’ll take them to their grave.

I have some solace in knowing that some decisions are made more difficult to carry through. I know that my son won’t be hopping in my car to zoom down the road, at least until he’s 15 or 16, because middle schoolers are too young to drive.  I know that my daughter won’t go off to buy cigarettes from the store until she’s around 18 (hopefully never) because that’s the age limit in North Carolina.  I know that neither will go off to buy a pint of Crown Royal until they’re 21, the legal drinking age in this state.  There are other such age restrictions which help to put my mind at ease.  I’m not so naïve to realize that loopholes can’t be found or that a friend or young adult might not sneak a drink or a smoke their way.  Still, I do know that such laws make access more difficult.

That’s why I support any efforts toward a ban on tanning beds for minors.  I know that my kids are good kids.  I know that I have parental control over these kids…now.  I also know that good kids (yes, I was a “good kid”) will purposely make a bad choice and then keep it a secret.  I’m convinced they will stay away from tanning beds.  But then again….

Kudos to our friend Chelsea Dawson for fighting for a tanning bed ban in Virginia.  Cheers to all others that have won the fights in their states or plan to continue the fight in others.  I wholeheartedly agree that parents should have the responsibility for their children and understand that every parent believes they have good kids.  Almost as good as mine.  But I also know that kids will make mistakes that can affect their lives in dramatic ways.  We might think our kids will make the right choices…but we might never know their secrets.

Basal Cell Carcinoma

By now, you’ve most likely seen this photo of Hugh Jackman.

 

The Wolverine himself announced to the world that he had skin cancer, basal cell carcinoma, removed from his nose.  The bandage wasn't because he had plastic surgery or was in a fight.  He had skin cancer.  This photo made it to all the entertainment news shows while the phrase “skin cancer” was simultaneously spoken.  That’s a good step to increasing awareness.  But what exactly is basal cell carcinoma and how serious is it?

Basal Cell Carcinoma (BCC) are abnormal growths from the basal cells of the skin, which are located in the deepest layer of the outer skin.   The very rarely spread to other areas of the body, but they can grow in size and become disfiguring if not addressed.

BCC usually occurs on skin that is exposed to the sun the most, such as on the nose, ears, face, scalp, neck, shoulders or back.  It can develop by other means (radiation exposure, contact with arsenic, tattooing, complications from burns, etc.) but UV radiation is the primary cause.

While anyone can get it, those with fair skin, red or blonde hair, and blue or green eyes are more likely to be diagnosed with BCC.  Treatments can range from topical medications, cryosurgery (“freezing it off”), radiation, or Mohs surgery.  Basal Cell Carcinoma is rarely fatal, but again, can become rather disfiguring and scarring, particularly if left untreated.

Skin cancer in general is diagnosed annually more than cancers of the breast, colon, lung and prostate combined!  BCC is the most common form of skin cancer with about 2.8 million occurrences diagnosed every year.

Basal Cell Carcinoma is very treatable and, unfortunately has led to the “simply cut out skin cancer” mentality.  But even if the treatment is that simple, multiple scars and potentially disfiguring surgery is never a preferred choice for anyone, particularly A-list Hollywood stars.  BCC can be quite serious, even if it is “just skin cancer.”

 

I invite you to visit the Skin Cancer Foundations website at www.skincancer.org for more information.