Cancer stole my teeth

Following on from “an eye for an eye, teeth for a breast”, the best I could do on calculating the odds went like this:

Odds of getting primary breast cancer (aged 36) = 1 in 215

Odds of getting primary breast cancer (aged 48) = 1 in 50

Odds of getting metastases from 1st occurence = 1 in 4 (with the proviso that this is a random guesstimate as, in the UK, there is no requirement for the NHS to record numbers of women presenting with secondary breast cancer, so no-one knows how many of us are out there)

Odds of getting metastases from 2nd occurence = 1 in 4

Odds of needing bisphosphonates = 100%

Odds of getting BONJ on oral bisphosphonates = 0.7 in 100,000

Odds of getting BONJ on IV bisphosphonates = 1 in 10 (and this probably increases over duration of treatment)

Median survival time after diagnosis of bone metastases  = 2 – 3 years

Long tail (outliers’) survival after diagnosis of bone mets = 10 years +

Odds of getting BONJ with crap teeth?   this is where you need the PhD in research and stats, because the numbers either aren’t out there or are way beyond my A level maths capabilities.

All of the above figures and statistics are my own take and best guesses based on extensive web-based research and double-checking with dental and oncological specialists, with the exception of the number of women living with secondary breast cancer, which comes from the Task Force on Secondary Breast Cancer.

So my final logic went a little like this: Do I want to get BONJ? No.  Am I hopeful of outliving the median of 2 years?  Hopeful, yes, whilst remembering that there are no guarantees (stark figures mean that if half the women exceed 2 years half don’t).  Have my teeth always been dodgy?  Yes.  Which rather boxed me into a corner.

Having forfeited a number of molars from my overcramped jaw as a teenager in a vain and abortive attempt at gaining a straight smile, then losing my four wisdom teeth as a student, I already found myself with 8 fewer molars/pre-molars than your average bear  [at this point a dear friend, who kindly but foolishly agreed to sense-check my first blog outings, has pointed out that brown and polar bears have 42 teeth – it really is amazing what you learn on a cancer journey!].

Even my molar roots have attitude....

My own dentist suggested I lose one or two more and the special care dentistry people at the hospital kindly removed three, whilst also admitting it’s a gamble, who knows, and did I know that BONJ can also start spontaneously disregarding the state of your teeth?  Deep and unabiding joy.  Which leaves me gummy, s(h)ibillant, virtually bite-less (only one top and one bottom molar match up, giving me a chomping area about the size of a stunted peanut), contemplating a forward life of mushy peas, ice-cream and smoothies, and not a little bit bitter and depressed about the whole caboodle.

If, like me, statistics left you cold at school then here’s a footnote on medians, just one of the many, far too technical resources I came across before resorting to bribery (old mate + beer + simple explanation)!  Usefully called intuitive biostatistics.  Obviously my intuition has exited stage left pursued by aforesaid bear, my health and increasingly my sense of humour.  Ho hum!