For millions of Americans every year, beating cancer is a private struggle that requires support from family, friends and doctors.
But Mayor Darwin Hindman and his wife, Axie, are happy they've made their bouts with numerous cancers public. It's allowed them to beat the disease with the support of an entire city.
Columbia's first couple, married for 47 years and with 12 years in the limelight as the mayor and wife, have never shied from talking about cancer's effects on their lives.
Darwin, who beat esophageal cancer in 2003, has begun a campaign to educate Columbians about the importance of early detection. He felt the need to do so after he was diagnosed with an early stage of prostate cancer at the end of 2006 — just before his campaign for re-election to a fifth term as mayor.
"I began to feel like a cancer veteran," he said. "I had been through it once but hardly knew where to turn."
Since announcing in January that he was undergoing treatment for prostate cancer, Darwin worked with the Columbia/Boone County Department of Health to create a new page on its Web site that features information about cancer prevention and early detection. The page features links to different sites that offer details about prevention, risk factors and treatment ideas.
"The mayor wanted to promote and create community awareness, and we created it as a community resource," Diedre Wood, health department spokeswoman, said.
With every one of their cancers — Darwin's esophageal and prostate cancer and Axie's breast cancer — the couple has cited early detection and education as the foundation for successful recovery.
"By the time you get educated, it's not as fearsome," Darwin said.
Axie was diagnosed with breast cancer in 1997; she said it wasn't entirely unexpected because her mother also had survived breast cancer and lived to the age of 98. Axie said she researched two treatment options: a lumpectomy, in which only the tumor is removed, or a mastectomy, in which the entire breast is removed.
"The flood of information is very stressful," she said. "We read as much as possible."
Axie didn't make the final decision about which surgery to have until the morning of the procedure.
"You really have to weigh the information available," she said.
Axie had a lumpectomy, and after follow-up radiation treatments was given a clean bill of health.
"My tumor was small enough because it was caught early," she said.
Both of Darwin's cancers were caught in the early stages because he was aware of risk factors associated with the diseases. In 2003, he was diagnosed with esophageal cancer. He had experienced two conditions that can lead to this type of cancer: gastric esophageal reflux disease and Barrett's esophagus, which is caused by repeated exposure of the esophagus to stomach acid.
"It was a big blow, but it wasn't entirely unexpected," he said.
Darwin had tests at the Mayo Clinic in Rochester, Minn., and one cancer cell was found during a biopsy.
"That's all they need," he said.
Darwin elected to have an extensive, six-hour procedure in which part of his esophagus was removed and a portion of his stomach was used to make a tube where his esophagus used to be.
"The surgery was a big deal," he said. "To a certain extent, I'll never be the same."
Darwin said he spent 2½ months researching options and where to have the procedure. At the time, the surgery wasn't performed in Columbia, so he had it done at the University of Pittsburgh. The procedure is now available at Ellis Fischel Cancer Center.
July 7 marks his fifth anniversary since the surgery.
"The statistics on esophageal cancer are awful," Darwin said.
According to the National Cancer Institute's Web site, about 5 percent of the population will get esophageal cancer, with black men being the most likely to have it.
The American Cancer Society estimates during 2007, 13,940 deaths from esophageal cancer will occur. According to the organization's Web site, because esophageal cancer is usually diagnosed at a late stage, most people with esophageal cancer eventually die of this disease. However, survival rates have been improving. During the early 1960s, only 4 percent of all white patients and 1 percent of all African-American patients survived at least five years after diagnosis. Now, 17 percent of white patients and 12 percent of African-American patients survive at least five years after diagnosis. These figures refer to patients with all stages of disease, so survival rates in earlier stage disease will be higher, the society's Web site states.
"It was definitely a life-changing event," Darwin said.
"It was a pretty dramatic time," Axie said.
Prior to his prostate cancer diagnosis, which was found two days before Christmas 2006, Darwin had previous physicals that detected a high count of prostate specimen antigen, or PSA, a warning sign for prostate cancer. He followed up with a biopsy that found the cancer.
John McMurtry and Mark Bryer, the doctors who treated Darwin's prostate cancer, attributed the success of the treatment to Darwin's proactive stance on his health.
"He's the penultimate of health maintenance," McMurtry said. "He had an ESD (esophagogastroduodenoscopy, also known as an upper endoscopy) and had esophageal cancer caught early. He was a man who judicially followed up on a PSA and underwent a biopsy that found very, very early (prostate) cancer.
"He's a gentleman who knows cancer is cancer, and that if you see a snake you kill it."
To treat his prostate cancer, Darwin underwent brachytherapy, which he said was not as traumatic as the treatment for esophageal cancer. Radioactive seeds were implanted in Darwin's prostate gland to treat cancer at the site.
McMurtry said that the procedure has been around for more than 15 years and that it has recently become popular because of its ability to localize treatment.
McMurtry said about 240,000 cases of prostate cancer are diagnosed each year in the United States. He said men older than 50 should be screened, and black men or those with a strong family history of prostate cancer should begin screenings at 40. According to the American Cancer Society, prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that about 27,050 men will die of this disease in 2007. It is the second leading cause of cancer death in men, the society reports. Lung cancer is the first. While one man in six will get prostate cancer during his lifetime, only one man in 34 will die of this disease.
Bryer said the mayor's positive attitude also gave his health a boost.
"A positive attitude is very important for treatment of all cancers," he said. "We see it all the time. The ones with a positive attitude maintain normal activities and do better with their treatment. Attitude plays a huge role, not just for prostate cancer but for all cancers."
Darwin said undergoing cancer treatments while running for his fifth mayoral term was bothersome, but he thinks it benefited the community.
"I had to turn down several campaign events, but it showed that you can live an active and productive life," he said.
Both Darwin and Axie said it's imperative to pay attention to one's body for warning signs.
"It's very important to be aware of your body and your symptoms," Axie said.
McMurtry said women by and large do better about being proactive with their health.
"Men just don't do it as much mostly because of denial," he said. "For guys who will go out and change their oil every 3,000 miles, it's odd that they won't check up on their bodies. Prostate cancer is either there or it's not. The question is whether you screen for it. Not being screened is not going to change the fact that it's there and it won't go away without treatment."
Today, Darwin and Axie attribute their success at beating cancer to the support they provided for each other and to the support the community provided them.
"One of the things you learn from this cancer business is how concerned you are for your spouse," Darwin said. "In some ways, you feel helpless, but Axie went with me to every doctor's appointment. She taught me the value of that, what a difference that makes."
Axie said Darwin's support helped her beat breast cancer.
"It truly is important to have someone else who is there, taking notes and listening," she said.
McMurtry said Darwin's candidness about his cancer benefits the community by raising awareness.
"God love him for talking about his lower half to put it on the map," McMurtry said.
Darwin said support and raising awareness are crucial to beating cancer.
"You need the support of family and friends for your general outlook," he said. "The best thing to do is to let people know, let the world know."