It’s been a little longer than usual since my last post. I try and make most of my posts about my knowledge of real estate, construction and sustainability whenever possible. (Yes, I do get into politics from time to time.) Sometimes, however I have to just let go. This one is for me. If you don’t want to see this personal side of me better skip this one. It could get heavy. On December 10, 2012 we found out that my wife Claudia had our second bout with breast cancer. Our last cancer experience was over 10 years ago so we were told we had past the important recurrence point some 3 years ago. So much for the numbers.
We found out about this cancer totally by accident. Claudia had been in an accident in March and we believed that her breast implant (from her previous mastectomy) had broken. She started getting small lumps on her breast which when checked out were silicon, not tumors. (Good news.) A radiology teckie also saw a shadow she didn't understand but thought should be looked at and so when we did the surgery to clean up the broken implant we had the breast surgeon remove and biopsy the mass that was found by the radiologist. That mass that turned out to be a 3mm invasive cancer with one edge unclear. There is obviously much more to this story but this is not the point of this post. (We are waiting for a confirmation of the next surgery as I write this). No, the point of this post is not about cancer. It’s about math, and our blindness to its reality.
This particular cancer is a very common form of breast cancer with the classic treatment options being either a lumpectomy with either radiation, chemotherapy or both after the lumpectomy or a mastectomy (the more radical approach). We were told by the doctors (both of whom we really like, trust and have faith in) that the recidivism rate for (Claudia’s specific case) and doing a lumpectomy (and follow up) was between .6%-.9% and the recidivism rate for the mastectomy was between .3%-.4%, “so they were both about the same.” Am I crazy? While math was not my best subject I was good enough to figure out that the difference between 7.5% (the average of the lumpectomy rate) and 3.5% (the average of the mastectomy rate) was 4% (or over 100% more likely). To me four more recurrences (and possibly an additional four deaths per one hundred) was a no brainer. We would go with the mastectomy.
I know that there may be a woman out there who have chosen the lumpectomy solution for their personal form of breast cancer and I don’t want to scare them or make them feel that they may have made a bad or incorrect choice. Remember, all cases are different and there are too many variables to go into in a short posting. These are all personal choices and I’m sure age is a consideration to some as well. I know that we would have viewed the options differently if Claudia was 30, not 64. I just want my readers to understand that too often we simply don’t do the math or more commonly, interpret it correctly (which is to say without bias.) The doctors view was that one had a 92.5% success rate and the other a 96.5% success rate. (Both very high and very positive.) While their numbers were correct, I felt that they were looking at the wrong side of the probability equation. The focus of this kind of decision making should not be looked at from the success rate, it should be looked from the failure rate and this rate was twice as likely.
We live in a world where everyone wants to surround themselves with points of view that they agree with and support their current opinions. They want to be “positive.” They don’t want to face the Black Swan. The Black Swan is a book about the “The Impact of the Highly Improbable.” The author, Nassim Nicholas Taleb, considers the most important events in our lives to be these Black Swans. Cancer is generally a Black Swan. How do highly educated doctors not see the significant difference in negative probabilities? The answer, easily. The Black Swan taught me to view predictions from the point of view of the possibilities of the highly improbable.
As we go about our lives, learning to listen to what we don’t want to, surrounding ourselves with contrary opinions and analyzing statistics honestly is important. You’ll find everyone has a point of view and philosophy that they are preaching with supporting data. Our surgeons wanted to do the lumpectomy. When asked why they had no real answer, just the numbers. My guess is we'll never know. I assume it’s less surgery but whether that’s really the reason is just a guess. The number of Black Swan possibilities that await us from hospital check in, to the surgery itself, to the results of the dissection of the lymph nodes are all areas of potentially great, or terrible news. Sometimes it comes down to luck, but an honest analysis of the facts, no matter what is shows is the best course of action. One of my favorite lines from the movies is from Dirty Harry, with Clint Eastwood. Sometimes you've gotta ask yourself a question: "Do I feel lucky?"
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