After losing someone close, the first feeling that arrives is often not grief but regret. Why didn't I arrange a check-up? Why did I say that on that particular day? Why did I never send them on a trip? Psychologists call this counterfactual thinking — the mind's habit of generating 'if only I had…' sentences. It is an old reflex: when something feels uncontrollable, the brain hunts for a cause so it can prepare for next time. It is not a strange reaction. It is one of the most common faces of mourning.
There is a reason the regret so often lands on screening. Once you know the outcome, the earlier signs look unmistakable. This is hindsight bias. What was, at the time, mild indigestion or a little more fatigue than usual gets re-sorted, now that a diagnosis exists, into 'signs anyone should have caught.' The trouble is that this re-sorting is done with the answer sheet in hand, not with the information that was actually available back then.
The medical facts matter here too. National cancer screening programs are built around cancers where screening has been shown to help — in Korea, stomach, colorectal, liver, breast, cervical, and lung cancer. Pancreatic cancer (pancreatic cancer) and biliary tract cancer are not included for people without symptoms. International guidelines likewise do not recommend routine pancreatic cancer screening in average-risk adults, because false positives and the follow-up testing they trigger can outweigh the benefit. A standard abdominal ultrasound often cannot see the whole pancreas — bowel gas and the organ's position can hide parts of it, especially the tail. The blood marker CA 19-9 is not a screening test: it can rise with a blocked bile duct or inflammation, and in some people it does not rise even when cancer is present. Structured surveillance with MRI/MRCP or endoscopic ultrasound (EUS) is discussed only for people judged to be at high risk — a strong family history, an inherited syndrome, certain pancreatic cysts, or new-onset diabetes together with unexplained weight loss.
Put plainly: an annual general check-up would not have guaranteed that this cancer was found early. And no one can state with certainty what a few extra months of lead time would have changed. Only one thing is certain — the judgment you are punishing yourself for was not one you could have made with the information you had at the time.
When self-blame swallows the whole day, a sequence helps. First, write the looping regret down exactly as it sounds in your head. Second, split it into two columns: what you could have known and chosen then, and what only became visible afterwards. Most sentences move to the second column. Third, at the bottom of the same page, write what actually happened — the stretch of time without severe pain, the months of holding a grandchild. This is not to erase the regret, but to keep the memory from compressing into a single line of failure. Fourth, protect the basics of the body: sleep hours, at least one proper meal a day, and no alcohol used as a sleep aid. Alcohol fragments sleep, and the self-blame returns louder before dawn.
You do not have to metabolize this alone. Many hospice and palliative care services run bereavement counseling or groups, and community mental health centers offer grief support. Seek professional help without waiting if the longing and preoccupation have not eased after roughly a year and daily life is still on hold, if self-blame has hardened into a conviction that you caused the death, if eating and sleeping have been broken for weeks, or if thoughts of not wanting to live cross your mind. That last one warrants help immediately; in Korea, the suicide prevention counseling line 109 is available around the clock.
This article is general information and does not replace individual medical or psychological care. Please discuss your own health concerns and emotional difficulties with your doctor or a mental health professional.