Undetermined Significance and the Cancer Lottery

This past Monday, my hematologist told me I have something called MGUS (Monoclonal Gammopathy of Undetermined Significance).

I like that phrase, “Undetermined Significance”. It reminds me of the Buddhist story about the farmer who ran into an old friend he hadn’t seen in many years, and the friend asked him how it was going. The farmer said that he had broken his leg a few months earlier, and the friend said, “That’s bad.” The farmer answered, “No, that was good, because my son, whom I haven’t seen in many years, moved back home to help out on the farm.” The friend said, “That’s good.” And the farmer said, “No, that was bad because my son is a terrible farmer. He nearly drove me into bankruptcy.” And the friend said… well, hopefully the point is clear, because I don’t remember all of the story. Every time the friend made a judgment call, the farmer contradicted him. What seemed bad was good, and what seemed good was bad.

MGUS, boiled down to a very basic definition, means that I have something called M proteins in my blood, and those M proteins could turn into cancer. MGUS is of undetermined significance because on its own, it is neither good nor bad. 80% of people who have MGUS do not develop cancer, but there’s always that other 20% who do.

I could be in that 20%. I could have cancer.

Having MGUS is like buying a lottery ticket: you can’t win the lottery without it. Or in this case, you can’t lose the lottery without it.  I have my cancer lottery ticket. I just need additional lab tests to tell me whether I’ve won or not.  While I wait for the test results, some of which the doctor warned me would take a week or more, I try to remember that phrase, “Undetermined Significance.” For now, I don’t have cancer.  For now, my MGUS simply exists, not one thing or another.  

Waiting is nerve-wracking. After almost a quarter of a century of being sick, you’d think I’d be more used to this. But maybe it never gets easier. Maybe that’s because most people would probably agree that unlike the farmer’s story, having cancer is not of undetermined significance. It has a very determined significance, and that significance is bad.

Has my MGUS turned into cancer or not? Has the undetermined significance declared its significance? If I’m clear of cancer this time, what about next time? The doctor said I will need to have my blood tested regularly for the rest of my life, so even if there’s no cancer now, there could be next time. Or the time after that. Or the time after that.

Too many people don’t find out they have cancer until it’s too late, so in this case, I have a warning, at least. And that’s good. If you have to have a bad disease, being prepared has to be helpful. Worrying about it isn’t particularly helpful, however. So is MGUS bad, then, or is it good? Or is it both? Or is trying to classify it – good, bad, or otherwise – a waste of time altogether?  Maybe so, but at least trying to decide whether it’s good or bad keeps me occupied so I’m not worrying about test results. And that’s got to be good.  Right?  

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