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One of the first things you notice is that people treat you differently when they known you have it. The hushed tone in which they inquire,” How are you?” is unnerving. If I had answered honesty during 90% of the nine months I spent in treatment, I would have said “If I weren’t for being constipated, I’d be fine. In fact, even chemotherapy is not nearly as hard as it once was, although it still made all my hair fall out. My late friend Jocelyn Gray found the ultimate proof that there is no justice. “Not just my hair, but my eyebrows, my eyelashes- every hair on my body has fallen out, except for these god dam little mustaches at the corner of my mouth I have always hated.

Another thing you get as a cancer patient is a lot of football coach patter. You can beat this; you can win;, you’re strong; you’re tough; get psyched “I suspect that cancer doesn’t give a rat’s ass whether you have a positive mental attitude. It just sits in there multiplying away, whether you are admirably stoic or weeping and wailing. The only reason to have a positive mental attitude is that it makes life better. It doesn’t cure cancer.

My friend Judy Curtis demanded totally uncritical support from everyone around her “ I smoked and drank through the whole thing “ she says,” And I hated the lady from the American Cancer Society My role model.

The late Alice Trillin wrote some brilliant essays on being a cancer patient, and I found her theory of “The good student” especially helpful. When you are not doing well at cancer- barfing and getting bad blood tests and generally not sailing through the whole thing with grace and panache- you have a tendency to think, help, I’m flunking cancer, as through if were your fault. Your doctor also tends to look at you as though he is disappointed. Especially if you start to die on him.

What she soon learned was that kind of cancer she had- a group of malignancies so tiny that they were rarely seen before the advent of mammograms powerful enough to spot them- is at the heart of raging debate in the cancer community. Doctors know what to do when they find tumors the size of marbles or plums. That’s what surgery, radiation and chemotherapy are for. But what do you do with cancers the size of pencil points? Do you treat them alone? Should you even be looking for them in the first place?

This year, according to the American Cancer Society, some 200,000 women (and 1,500 men) will learn that they have breast cancer- up from a little more than 100,000 two decades ago. While the death rate from the disease has dropped modesty over the past decade, there is a growing sense of frustration among cancer experts. Part of the problem is DCIS. Thirty years ago, these miniature tumors, which usually don’t spread into the rest of the body, were diagnosed in some 6% of breast cancer patients. Today the ratio is closer to 20%, largely because of advances in detection techniques. Yet the treatment of choice is still surgery followed by radiation. “We may be far over treating our patients” says Dr. Julie Gralow, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle. “We’ve now got women being diagnosed with tumors that probably never would have been treated if we didn’t have mammography. They probably would have lived long, natural, healthy lives never knowing they had breast cancer.