As Sarah’s eyes widened and an expectant hush simmered in the room, I knew that this was a ‘big moment’. As any teacher will know, a ‘big moment’ is when a spontaneous silence arrives in a classroom and everyone is listening intently, gripped by what might be said or revealed next. This is different from other teacher silences; the shouted-into-submission silence, the threat-and-consequences silence, even the busy-doing-work silence. A ‘big moment’ silence is much rarer and more interesting - invariably more consequential. It comes, often unbidden and unexpectedly, perhaps when a class discussion is taking place and when someone asks a question or says something which is incredibly pertinent and students are intrigued as to how the teacher will respond. Even the kids who do a cunningly effective job of looking like they are paying attention are actually paying attention.
Sarah had asked, during a Year 8 life skills lesson on smoking (basically PSHE), if the years she spent as a young girl inhaling her father’s second hand cigarette smoke meant that she might get cancer. Pause… and boom! BIG MOMENT silence!
What should I say to wide-eyed Sarah, a sparky, intelligent thirteen-year-old? To say ‘no’ would be to lie. To say ‘yes’ would be, well, harsh? Insensitive? Potentially problematic with the parents? Take your pick. An added frisson was attached to this moment by the fact that the class all knew that I have cancer, serious prostate cancer which has been well treated and is currently well managed.
How to explain the nuance of risk and statistics, of lifestyle choices, of genetic predispositions? Of luck - and of bad luck? As they all knew - my cancer occurred through no obvious markers of likelihood; not obesity, not smoking, not poor health, not (as far as I know) through genetics…
Before my diagnosis, I had always treated the concept of risk and statistics as something potentially interesting, but really just for geeks, and not really what I wanted to spend my time diving into. A bit like Warhammer. From what I understood, there was an inherent risk in a massive range of things, and that our brains (and the media) inflated some risks to totally disproportionate levels; such as the risk of flying versus traveling by car. I also understood that statistics are often used in misleading ways, and had to be dealt with carefully.
But now I am a statistic; and an unlikely one.
The chance of a man under the age of 50 being diagnosed with prostate cancer is 1 in 456 or 0.22%. But this statistic doesn’t account for a large number of variables: your weight and BMI, whether you smoke or not, your diet and level of exercise, your exposure to pollution. Your genetics. We know that our risk of pretty much all cancers increases with age, and that 1 in 2 people will get cancer. 90% of men die with some evidence of prostate cancer - the operative word here being ‘with’ not ‘of’. But what unseen risks had I exposed myself to? Those relatively few cigarettes in my younger years? Invisible pollutants or carcinogens absorbed unwittingly - perhaps during my 6 years living in Vietnam? Was it due to my eating fried egg baguettes most mornings before school from that lady’s food stall outside, the lady who used that knackered old pan, which was probably slowly but consistently shedding its carcinogenic non-stick coating into each batch of fried eggs? It is a blind alley, bringing no answers and no joy - just frustration and an endless concertina of ‘what ifs’.
Focusing on the aspects of my life over which I have control is my way of navigating risk. I know that I can - and do - eat healthily, cutting down on alcohol and sugar. I know that I must keep a regular regime of exercise - strength training to counterbalance the loss of muscle caused by my hormone therapy. I make an effort to avoid or at least minimise imbibing known carcinogens such as cigarette smoke, highly processed foods and red meat. Yes, to a certain extent the ‘horse has bolted’ with regards to carcinogens, but evidence points to a healthy diet and lifestyle making my treatment more effective for longer and increasing my life expectancy.
Ultimately, it was this ethos which led to my response to Sarah and the ‘big moment’. Here is an approximation of my words at the time:
Sarah… please don’t look so worried. There are so many factors which we have control over and ones we don’t have control over. Yes your Dad’s smoking did add a small element of risk, but he has stopped now, so that was only a few years [fortunately, this was true]. Evidence also shows that smoking for a while but then stopping gives your body a chance to recover and heal, and this can repair damage from smoke [also true]. The important thing is that you stay healthy and don’t smoke yourself. The risks that we can’t control are not worth worrying about because there are loads that we can control. Make good choices and you will minimise your risk of getting cancer - I can’t promise that you won’t get it - no-one can for anyone - but we can at least give ourselves the best chance of a long and healthy life.
Amen to that.
