Two things made me think of this. First, as a surgeon, you don't generally see your patients recur during training because you are only on one surgical service for a couple of months at a time. Since taking my first faculty job, I've been at the same place for five years now. This means I'm starting to see some patients that I operated on two or three years ago come back to medical oncologists (who are in clinic with me on the same day) with recurrences or metastatic disease. One patient in particular, whom I operated on two years ago, came back last week with widely metastatic disease last week. This happened despite her having had a "curable" (albeit high risk) tumor (3 cm, 1 out of 20 nodes positive for tumor, estrogen receptor positive), proper surgical therapy, and proper adjuvant chemotherapy and hormonal therapy. It made me remember that, even in the case of a tumor the disease-free surival rate is 60% or 70%, that means 30% or 40% are going to recur and die of their disease, even with absolutely optimum therapy. Even for early stage breast cancer (small tumor, no axillary lymph node metastases), which can have a 90-95% long-term disease-free survival rate, that means that 5-10% of these very "curable" patients will recur and die. As a surgeon and a doctor, I'm humbled when I think about this.
The other thing that got me thinking about this is this particular post in Dr. Hildreth's excellent blog. His observations remind me of why I probably couldn't be a medical oncologist (which is actually what I wanted to be before the my third year of medical school) and why I admire those who can do it and do it well. I highly recommend his blog; since I discovered it about a month ago, I never mist a post. He may not post every day, but his posts are worth the wait. If my posts on medical issues can be half as insightful as his, though, I'll have succeeded on medical aspect of the blog better than I could have hoped.