Last October I gave a series of lectures in Panama City, which was completely adorned with pink ribbons. The former First Lady of Panama was a patron for the breast cancer community, and through her support every major landmark and building was wrapped in pink. There was literally a pink ribbon everywhere you looked, adorning the airport, the shopping centers, the presidential palace, and even the Panama Canal. It was a wonderful way to raise awareness of a disease that affects over one in eight women over their lifetime.

Every October, we see this same level of enthusiasm in cities across America, which hopefully translates into more women getting their mammograms and feeling connected to their bodies and their medical communities. A disease that for so long had been silent and associated with stigma has finally found its voice and its power base.

With more women surviving breast cancer than ever before, we now have an “army” of women to help raise funds for research and education. Often the best salve or medication for one who has experienced a life altering or life threatening illness is the ability to help others facing a similar situation. But how does one define being a survivor? Is a survivor someone who has gone through chemotherapy, surgery, and/or radiation and is still able to get up in the morning and face the new day? Is a survivor someone who has been disease free for a year, five years, or 10 or more years? Or is a survivor someone who has faced multiple bouts of cancer and yet still has a hope and indefatigable desire to live?

I never really thought much about these questions until a few months ago when I went cross-country skiing with my friend. She was diagnosed with breast cancer five years ago and endured the ordeal of chemotherapy. This past winter, she was diagnosed with metastatic breast cancer after doctors found tiny spots on her lungs. As we were gliding along a winding trail, she said she was sad that she could no longer call herself a survivor. While she doesn’t feel ill and is able to do all the activities she did before this new diagnosis, she now fell into a new category: “a patient with incurable cancer.” My friend still feels like a survivor, though, and has found joy and peace in her life. She has a desire to help the world through her spiritual training and doesn’t want to be thought of as a terminal case...someone who was not a survivor.

Watching my friend and others navigate the challenging path of incurable cancer got me thinking about what it means to be a survivor. Like many, I followed Senator Ted Kennedy’s valiant struggle to continue serving his country until the very end of his life despite having a brain tumor. (I will always be grateful to him for his support of an important piece of legislation to provide mental healthcare for our troops this past June 2009). We all watched in awe as Patrick Swayze, battling Stage 4 pancreatic cancer, not only starred in a television series, but wrote a book and spoke publicly about pancreatic cancer. My mother, who also fought pancreatic cancer, felt like she had a brother in him during her journey to combat the disease. (She did not die from pancreatic cancer, but from medical errors leading to a hospital-acquired infection). She also never gave up hope and continued to care for her family and community with her audacious sense of humor and honesty. She served as my editor for some of my articles and even for my new book, which will be published this coming year.

All of these men and women are survivors! They lived their lives fully and with a sense of purpose. They never gave up and they never gave in. Although they may always be associated with the cancer that infiltrated their lives, they survived it to be champions for those they loved and served. Their legacies live on.