I was in my mid-40s when I found a lump in my left breast. It wasn’t long before doctors detected cancer on the right side as well, and soon after that I was meeting with a plastic surgeon to discuss reconstruction. Before I knew it, I was being wheeled into an operating room for a double mastectomy. I just kept wanting to slow everything down — to breathe and process my cancer — but there was no time.

My kids were 14 and 8, and I have to admit that I didn’t think a lot about how my illness was affecting them. In the blur of the moment, I wasn’t a very attentive mother. In fact, for a few months, many of the things that I thought defined me — maternal devotion, work ethic and a rational mindset — moved to the periphery.

Lesson number one: Cancer can make you unrecognizable to yourself, physically or otherwise.

Because I discovered the cancer at an early stage, I avoided chemo and radiation. Now, nearly 20 years later, I’m still here, and have suffered no relapses yet, knock wood. I’ve seen my kids graduate high school and move into college, careers and, in one, case marriage. I’ve found joy in travel, hiking, boogie boarding and snorkeling over the years.

Lesson number two: Be grateful that you lived to tell. 

I’m one of many people who are increasingly living longer with or past cancer. In the 1970s, only 49 percent of patients survived five years after their illness, but that rate has risen to 70 percent. Doctors now commonly talk about cancer as a chronic disease which can be managed.

The changes are due to advances in treatment and earlier detection, and they are reflected most among aging people, who are by far the most likely to get cancer. 

But even as older cancer patients receive the gift of extra time, greater longevity brings its own challenges, including the possibility of a new cancer, or the return of an old cancer. Grueling procedures such as chemo and radiation are even harder on older bodies the second time around.

And many elderly cancer patients are already dealing with other medical conditions, according to Irvine Geriatrician Dr. Katherine De Azambuja.

“The biggest challenge is when I have patients in their mid to late 80s who have other chronic diseases and, on top of that, stage 4 cancer and are pursuing treatments,” De Azambuja said.

Newer treatments to stave off cancer’s comeback bring side effects, such as when hormone blockers cause a loss of hair, energy or libido. In my case, I was prescribed tamoxifen to stop estrogen from connecting to breast cancer cells and accelerating their growth. The medicine was difficult to tolerate, and so, after consulting with my oncologist, I didn’t complete the full dose. 

Lesson number three: The adage about the cure being worse than the disease can ring true.

One key to living longer after cancer is the discerning eye of a doctor who can recognize the disease’s return early, at a treatable stage, before a patient would spot the signs. Such was the case for one patient in De Azambuja’s practice recently.

“She is a woman in her 60s and she had endometrial cancer years ago. She was in remission and in the clear,” De Azambuja said. But in an office visit, the doctor noticed her lungs  “sounded off.” De Azambuja requested an X-ray and confirmed there was fluid in the lungs, which led her to identify a recurrence of the endometrial cancer.

But you can’t benefit from a doctor’s vigilance unless you have access to regular care.

“A lot of uninsured and underinsured (patients) go un-doctored and don’t go through the screening process. By the time they see a doctor, whatever is going on may have gotten worse,” according to De Azambuja, who said that for many low-income Californians, the emergency room is still their regular medical provider.

This is just wrong, and it needs to be corrected. Filling the gaps in coverage among the unlucky, the disadvantaged and the medically needy should be a national priority. In the meantime, doctors like De Azambuja are working to point their low-income patients to resources they might not know about.

“There are specialists who are able to provide services for a sliding scale. A lot of family health centers have resources,” she said, noting that social workers can help patients identify insurance options, including Medi-Cal. But Medi-Cal is set to take a huge hit, due to federal cutbacks in about two years; the impact of this on lower-income cancer patients isn’t yet clear.

Lesson number four: Health care is a right.

After my surgery, my doctor congratulated me on being a survivor, though the joyful survivor persona didn’t exactly suit me. Still, cancer changed my life, and in some ways for the better. I started taking exciting vacations in places like Rome, Mexico and Ireland, because, why wait? I resolved to spend more time in the outdoors, knowing that breast cancer can spread to bone and other parts of the body which could circumscribe mobility. I also resolved to focus my reporting on public health issues, including people who don’t have the same resources I had during my illness. And I tried to be open about my cancer, or at least not hide it, even though I have always had some ambivalence about sharing this information.

I remember when I took part in a breast cancer 5K, the “Race for the Cure,” wearing my pink survivor shirt and cap. This was within a few years of my surgery. The course took us on a circuitous path around a posh shopping plaza in Newport Beach. The race vibe was upbeat; along the route, racers were spurred on by cheerleaders, a mariachi band and kids handing out cups of water.  During the run, a fellow runner nearby turned to me and said, “You’re my hero.” Bless this lady — I know she was showing me love and support. But I am not a hero, and the moment felt uncomfortable.

Lesson five: Cancer survivorship is complicated, and that’s OK.

We are an army of survivors some 53 million people strong worldwide. Most of us are older. Some of us are bitter. Some of us are joyful. Some are hobbled and need a walker or a chair. Others run marathons. 

We are also, for the moment anyway, undefeated.

Amy DePaul is a California Health Report columnist who writes about aging and health equity.