In medicine, every decision carries a risk. And there are few areas where this is more relevant than in oncology.

• Surgery removes cancer cells but risks infection, bleeding, anaesthetic risks, and blood clots.
• Chemotherapy kills cancer cells but carries serious toxicities including febrile neutropenia, alopecia, and anaemia.
• Radiotherapy irradiates cancer cells but can cause long-term skin damage, fatigue, and delayed wound healing.
• Even a simple CT scan to stage a cancer has 10-20mSv of radiation – equal to about three years of background radiation.

With all these risks, it sounds easier to do nothing. A very reasonable decision. Why risk all this?

But the thing we forget: doing nothing carries a significant risk as well. The cancer progressing further. No action is still an action.

The real question is then: what risks will you bear for a given outcome? For most people, the greater the outcome – say, a complete remission – the more toxicities we risk.

The mistake is thinking that doing nothing is a safe way out. All our actions, and equally all our inactions, have consequences we must bear.