When people hear the words "You have cancer," life is suddenly divided into distinct parts. There was their life before cancer, and then there is life after cancer.
The number of people in that second category continues to grow. In June, the National Cancer Institute reported that an estimated 13.7 million living Americans are cancer survivors, and the number will increase to almost 18 million over the next decade. More than half are younger than 70.
A new book, "Picture Your Life After Cancer," (American Cancer Society) focuses on the living that goes on after a cancer diagnosis. It's based on a multimedia project by The New York Times that asked readers to submit photos and their personal stories. So far, nearly 1,500 people have shared their experiences — the good, the bad, the challenging and the inspirational — creating a dramatic photo essay of the varied lives people live in the years after diagnosis.
For Susan Schwalb, a 68-year-old artist from Manhattan, a diagnosis of early-stage breast cancer at the age of 62 led to a lumpectomy, followed by a mastectomy and then failed reconstruction surgery. She discovered that cancer was not only a physical challenge but a mental one as well, and she turned to friends and support groups to cope with the emotional strain. When she saw the "Picture Your Life" project, she submitted a photo of herself wearing a paint-splattered artist's apron.
"What cancer made me do in my own professional life is to pedal faster," Ms. Schwalb said in an interview. "I've encountered some people who decide to enjoy life, retire, work in a garden. I decided I had to have more of what I wanted in life, and I better move fast because maybe I don't have the long life I imagined I would have."
Indeed, a common theme of the "Picture Your Life" project is that cancer spurs people to take long-delayed trips, seek out adventure and spend time with their families. Photos of mountain climbs, a ride on a camel, scuba diving excursions and bicycle trips are now part of the online collage.
Dr. David Posner, associate program director of pulmonary medicine at Lenox Hill Hospital in Manhattan, says a diagnosis of metastatic colon cancer at the age of 47 has helped him relate to his own patients with cancer. The past decade has included nine operations, six recurrences and three rounds of chemotherapy, but Dr. Posner said he never missed more than three weeks of work.
"My salvation has been my family and my work," he said. "When I was at work I wasn't thinking about myself, and it was very therapeutic. I see my share of cancer patients, and I motivate them and they motivate me."
Dr. Posner said he decided to be part of "Picture Your Life" because he wants to get the word out that a cancer diagnosis — even a dire one like his — doesn't have to define your life.
"I think about someone asking me, 'So how was your last decade — was it wasted or was it a life filled with a lot of happiness and joy?' " he said. "The cancer thing was a pain, but for the most part I've had a pretty good time."
The "Picture Your Life" collage includes photo after photo of survivors with their pets. Sandra Elliott, 59, of Claremont, Calif., submitted a picture of herself with her two golden retrievers, Buddy and Molly. They were just puppies when she received a diagnosis of Stage 2 breast cancer in 2003. During her recovery from surgery and chemotherapy treatments, she took the dogs to romp on the Pomona College campus, near her home, and one day a professional photographer snapped the picture.
"No matter how bad I felt that day, no matter how many chemo treatments or doctors appointments, those two little puppies with these big black eyes would look at me with their tails wagging as if to say, 'It's time. It's time. It's time to go out!' " Ms. Elliott recalled.
"I felt so physically horrible, and I'd look at them and the pure joy on their faces and in their bodies for just being out in nature and being able to smell the air, smell the trees, chase a squirrel — that sheer in-the-moment love of life they showed me really lifted my spirit on a daily basis."
Ms. Elliott still lives with chronic pain as a result of nerve damage from her cancer treatment, and she can relate to others in the "Picture Your Life" project who worry that their cancer will recur or that they'll never feel completely normal again. But she says a stronger theme runs through all the pictures and stories.