Jan's oncologist came into the consultation room and didn't say hello, good morning, or anything by way of pleasantries. Just, "I'm afraid I've got some bad news." Then he explained to us that her breast cancer had returned in her bones, and the scans showed it to be in her skull, her vertebrae, her ribs, her hips, her knees, and her ankles. Practically head to toe.

August 27, 2008, 11:00 a.m.: A time and an appointment forever burned into my memory. As Dr. Westberg talked about the next steps we must take, I asked through muffled sobs if there might be some mistake, maybe something besides cancer causing those hot spots on the scans.

"There's always that chance," he said, "but I've been doing this a long time. I don't know what else it could be."

Continue article

ADVERTISEMENT

We did all the radiation and hormone treatments by the book, but Jan passed away just four and a half months later of metastatic breast cancer. She was 63.

There are lessons to be learned from everything. I'll share three that Jan would want others to know, especially those who are coping with life after cancer.

1. Never be complacent. It was 12 years between Jan's original cancer and its return. That's a long time for the cancer cells to remain dormant, but it's not unheard of. One doctor told us of a woman who went 29 years from her original cancer until it returned.

   Cancer survivors tend to think that if you make it five years from your diagnosis, you're cured forever. That's a myth from the often-quoted percentages for survival rates -- your statistical odds of making it five years. For breast cancer, it is now up to an incredible 98%. But it doesn't mean it won't return at five years and one day -- or 12 years later.

   It pains me to say it, but Jan and I had stopped thinking about her cancer, stopped looking for symptoms of its return, stopped being vigilant. I've been told that an earlier diagnosis wouldn't have changed anything. But I do wish we had been able to fight it head-on before it reached such an advanced stage.

2. Look elsewhere. After Jan's original breast cancer was diagnosed, she had a lumpectomy, then radiation and chemotherapy treatments as prescribed. She dutifully did all of her follow-up appointments and tests by the book. She never missed a mammogram appointment, and they were always clean.

   Then in the last year of her life, she started having midback pain, subtle at first, then more and more acute. She said it felt like "someone taking my ribs and twisting them like a dishrag." As it got worse, she went to our family doctor, who sent her to specialists and chiropractors and physical therapists. Through those several months, all we thought of were the usual causes of back pain  muscle strains, arthritis, pinched nerves. It seemed so far removed from breast cancer that we never asked, "Could this be the cancer returned?"

   At her annual appointment with Dr. Westberg, Jan had another clean mammogram. Almost in passing, she mentioned the back pain that wouldn't go away. He looked closer at the chest X-ray, saw the slightest hairline vertebrae crack, and ordered the full bone scan that revealed the awful news.

   As it turns out, when breast cancer recurs, it's often someplace other than the breast; 25% of the time it comes back in the bone and 21% in the lungs. It also recurs in the liver and the brain. The lesson: cancer survivors need to listen to their whole body and avoid self-diagnosis. See the doctor you trust and let him or her tell you it's a pinched nerve and not cancer.

3. The Mack truck principle. When Dr. Westberg diagnosed the return of Jan's breast cancer, he said we wouldn't cure it, but we'd do all we could to hold it in check for "a good, long time." We were too afraid to ask him to define that.

   But Jan went home and started looking online for the answer. On average, how long does it take for this to run its course? That evening, she told me she didn't like what she was seeing, so she shut off the computer. "I'm going to live by the Mack Truck Principle," she announced.

   "What in the world is that?" I asked.

   "Well, they can tell you you've got a year to live or two years or five. But what they don't know is that tomorrow you could get hit by a Mack truck. In that case, your life expectancy is one day. I'm going to live every day like I could get hit by a Mack truck tomorrow."

Jan was the wisest person I've ever known. She was a schoolteacher, and I know she's in Heaven now, still sharing lessons with all of us.

After 32 years at Successful Farming magazine, Gene Johnston retired as managing editor in August 2008.