Jim Baen's Universe

In My Opinion

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Chemo For Algernon

Written by Mike Resnick

Like most people, I grew up in a household where cancer was considered the deadliest killer of all, and where the word itself was uttered only in hushed whispers. I suspect if we'd been Catholics we'd have crossed ourselves every time we mentioned it.

So when Carol, my wife, was diagnosed with breast cancer in 1999, it looked an awful lot like the end of the world.

Just goes to show how out of touch with science even a science fiction writer can be.

First of all, they didn't have mammograms when I was growing up; they do now. The cancer showed up on a routine mammogram. It was still microscopic. Twenty-five years ago it would have gone undetected until it formed a discernable lump, at which point the very best Carol might have hoped for was a mastectomy, and the likelihood of it killing her was better than 50-50.

But this cancer was only two cells wide. Cells, not inches or centimeters.

The first step was to cut it out. It wasn't a mastectomy. It wasn't even a lumpectomy. It was a one-inch incision that removed an area about the size of a golf ball—considerably larger than the affected area. Outpatient surgery. She was home an hour after they finished.

They did some more mammograms, and determined that they'd cut it all out. We thought they were done—and ten years ago they would have been—but they then suggested to Carol that she undergo radiation treatments and start taking the medication tamoxifen citrate. Why, we asked, if the cancer was gone? Because, they explained, the radiation treatments—there would be thirty-three of them—would catch any stray cancer cells they might have missed, and the tamoxifen (she would take one pill daily for the next five years with absolutely no side effects) would just about guarantee that the cancer would never recur.

Just about? Right. The odds of recurrence were 20% without the radiation and the tamoxifen, and less than 1/2 of 1% with them. Carol can count as well as the next person, and liked 200-to-1 odds better than 4-to-1, so she agreed to the treatments.

That's when our friends decided to warn us off. Her hair will fall out. She'll be vomiting day and night. She'll lose forty pounds. I'm surprised that they didn't suggest that the enamel on her teeth might melt.

Turns out they were as uninformed as I was. Yes, twenty and thirty years ago radiologists bombarded a cancer patient rather indiscriminately with cobalt, which often did as much harm as the cancer itself . . . but twenty years in the field of medicine is like two thousand years in the field of archaeology—ancient history.

They still use cobalt, but they were able to pinpoint the radiation so it hit only the target, nothing else; the trunk of her body was never radiated. The treatments took about a minute each; she'd enter the hospital's radiation lab at 1:00 every afternoon, and be done ten minutes later. She never got sick. She never lost her hair. She never vomited. The only side effect was a slight "sunburn" after about twenty-five treatments.

In short, the appearance and cure of this dread disease was pretty much of a non-event.

The oncologist seemed resigned to the fact that people didn't know about the enormous steps that have been made in the treatment of cancer. I was sure it was the Number One killer of Americans; I discovered it was Number Four, and moving down the list rapidly.

Early detection is the key, of course, and thanks to the CATscan and the mammogram they can detect things much earlier than they used to. But it's not just those two remarkable machines. For example, any man over fifty can—and should—get a PSA blood test every year, and they can tell from it whether or not he has (or is likely to soon have) prostate cancer.

The greatest weapon, once cancer is found, is no longer the scalpel, but chemotherapy. Chemo, like radiation, used to make the patient horribly sick on its own. I remember that my mother, who died of cancer twenty