If you're reading this, I guess I'm not dead yet. I'm writing early in the week, but on Thursday I'm scheduled for surgery for uterine cancer. The surgery is not the scary part, though I don't suppose it'll be fun. One just needs to make sure everybody knows what to do in case one is not around afterward, and publishing a posthumous column is probably not advisable. Actually it would be rather creepy, not that I'd be around to care. Cancer is the scary part. My gynecologist, Dr. Lynette Vialet at Kaiser Permanente, said when she told me the diagnosis that surgery would be an effective treatment in about 97 percent of cases. But on the long list of things they're going to do to me while I'm unconscious is something called ``staging.'' The expectation at this point is that the cancer will prove to be Stage 1, very unlikely to have spread. But if it's clawed its way deeper than half-way into the muscle wall of the uterus, then she'll have to examine the nearby lymph nodes to see whether there's cancer there, and if so then I've started down a long dark road. Statistics only applies to groups. Whatever has happened to me has already happened; I just don't know yet what it is. I feel rather like Schroedinger's quantum-mechanical cat, both alive and dead in a probabilistic universe until someone opens its box to check. Then it's one or the other. The reason I'm in this situation, most likely, is that for more than two years I have been taking tamoxifen to help prevent the recurrence of the breast cancer I had in 1996. You may not be interested in the state of my health, but you might someday have to decide whether you should take the drug. The Food and Drug Administration, just a couple of weeks ago, approved it for use by women who don't have breast cancer but have a high risk of developing it. Dr. Catherine Azar, my oncologist _ having had cancer before, I already have an oncologist _ said the tamoxifen is the probable cause of the cancer I have now. It's a rare side effect, she told me, and I'm the first of her patients to experience it. ``I don't suppose that makes you feel better,'' she said, but actually it does, though slightly. If it were a common side effect, then the decision to take the drug would be a bad decision _ not only in hindsight, after the dice have been thrown and you've lost _ but at the time. I'd hate to think I put my life in danger by doing something really stupid. Unlucky is just unlucky. I stopped taking the tamoxifen as soon as they knew what was wrong with me, but Azar said when I'm recovered form the surgery she'll want to start it again. Sounding as if she anticipated some resistance on my part to this suggestion, she explained that there wouldn't be any further risk, because the only organ that's affected in this way is the uterus, and I won't have one of those any more. Makes sense to me. The five-year survival rate for patients with a Stage 1 breast cancer like the one I had is about 90 percent, after a mastectomy that showed no sign of spreading to the lymph nodes. It goes down gradually over those five years, until it merges into the background rate for women of my age and circumstances. So even though I'm one of the unlucky few who develop uterine cancer, it was still the right bet to place. Unless the surgery reveals something much more deadly than they expect, I'll just have two five-year clocks ticking away. Sometimes I wonder how I got into this; did I do something wrong? Probably not. Breast cancer is very common, and among the major risk factors _ age, age at first menstruation, age at birth of first child, history of breast biopsies (four, so far, of which one was malignant) and family history _ I have all but the last. But I was taking estrogen replacements, and that may have contributed too. Was that decision bad? I don't know; osteoporosis is also a serious problem for women as they age, and estrogen therapy helps to prevent it. No one can thoughtfully sign those informed-consent forms for surgery and not be apprehensive about the outcome. Eventually I'll find out whether I have more to be apprehensive about. If I'm lucky, it won't be for a long time. ®lm0¯®rm80¯ CMD WEB MA80LI SLUGCCANCER PRI SECT ED DATE00/00PAGE FMT LE HJ NOTESnov 15 NEXTQlseeba THISQLSEEBA-NEW IN LASTLSEEBA;05/12,19:18FROMLSEEBA;11/11,17:59VER01 CX1 CUR1 FORMS MODELI BYLSEEBA;11/11,14:54SIDE MSG DI ®RM80¯If you're reading this, I guess I'm not dead yet. I'm writing early in the week, but on Thursday I'm scheduled for surgery for uterine cancer. The surgery is not the scary part, though I don't suppose it'll be fun. One just needs to make sure everybody knows what to do in case one is not around afterward, and publishing a posthumous column is probably not advisable. Actually it would be rather creepy, not that I'd be around to care. Cancer is the scary part. My gynecologist, Dr. Lynette Vialet at Kaiser Permanente, said when she told me the diagnosis that surgery would be an effective treatment in about 97 percent of cases. But on the long list of things they're going to do to me while I'm unconscious is something called ``staging.'' The expectation at this point is that the cancer will prove to be Stage 1, very unlikely to have spread. But if it's clawed its way deeper than half-way into the muscle wall of the uterus, then she'll have to examine the nearby lymph nodes to see whether there's cancer there, and if so then I've started down a long dark road. Statistics only applies to groups. Whatever has happened to me has already happened; I just don't know yet what it is. I feel rather like Schroedinger's quantum-mechanical cat, both alive and dead in a probabilistic universe until someone opens its box to check. Then it's one or the other. The reason I'm in this situation, most likely, is that for more than two years I have been taking tamoxifen to help prevent the recurrence of the breast cancer I had in 1996. You may not be interested in the state of my health, but you might someday have to decide whether you should take the drug. The Food and Drug Administration, just a couple of weeks ago, approved it for use by women who don't have breast cancer but have a high risk of developing it. Dr. Catherine Azar, my oncologist _ having had cancer before, I already have an oncologist _ said the tamoxifen is the probable cause of the cancer I have now. It's a rare side effect, she told me, and I'm the first of her patients to experience it. ``I don't suppose that makes you feel better,'' she said, but actually it does, though slightly. If it were a common side effect, then the decision to take the drug would be a bad decision _ not only in hindsight, after the dice have been thrown and you've lost _ but at the time. I'd hate to think I put my life in danger by doing something really stupid. Unlucky is just unlucky. I stopped taking the tamoxifen as soon as they knew what was wrong with me, but Azar said when I'm recovered form the surgery she'll want to start it again. Sounding as if she anticipated some resistance on my part to this suggestion, she explained that there wouldn't be any further risk, because the only organ that's affected in this way is the uterus, and I won't have one of those any more. Makes sense to me. The five-year survival rate for patients with a Stage 1 breast cancer like the one I had is about 90 percent, after a mastectomy that showed no sign of spreading to the lymph nodes. It goes down gradually over those five years, until it merges into the background rate for women of my age and circumstances. So even though I'm one of the unlucky few who develop uterine cancer, it was still the right bet to place. Unless the surgery reveals something much more deadly than they expect, I'll just have two five-year clocks ticking away. Sometimes I wonder how I got into this; did I do something wrong? Probably not. Breast cancer is very common, and among the major risk factors _ age, age at first menstruation, age at birth of first child, history of breast biopsies (four, so far, of which one was malignant) and family history _ I have all but the last. But I was taking estrogen replacements, and that may have contributed too. Was that decision bad? I don't know; osteoporosis is also a serious problem for women as they age, and estrogen therapy helps to prevent it. No one can thoughtfully sign those informed-consent forms for surgery and not be apprehensive about the outcome. Eventually I'll find out whether I have more to be apprehensive about. If I'm lucky, it won't be for a long time.