We’re laughing about cancer. Sort of. There’s nervous laughter. Then long stretches of silence. Then some guarded laughter. Then the silence becomes awkward. Really awkward. He’s Lance Armstrong, still the world’s most famous cancer survivor. And we’re in the study of his West Austin home, huddled around his laptop, laughing about cancer. Sort of.

On a much smaller scale, this might be a little like how it felt to have been at Los Angeles’s Largo Theater on August 3 when comedian Tig Notaro opened her set with this:

Hello. Good evening. Hello. I have cancer. How are you? Is everybody having a good time? I have cancer. How are you?

On the live recording Lance and I are listening to of Notaro’s set, released today as a download on Louis C.K.’s website, you can hear a smattering of nervous laughter from the audience, which seems unsure whether she really just went there: Did she just joke about having cancer?

But it was no put-on. A day before her Largo appearance, Notaro learned she’d been diagnosed with stage 2 bilateral breast cancer. Her thirty-minute set that night–which addresses not just her cancer, but the recent loss of her mother, a breakup, and a battle with a life-threatening bacterial infection–is noticeably, and understandingly, short on punch lines, but also undeniably raw, brave, and emotionally confusing. In the recording you can almost hear the audience’s hesitation. Does what they’re hearing deserve laughter or tears? Or both simultaneously? As we listen to the album, titled LIVE (as in “to live”), I’m looking at Armstrong for cues. He’s the guy who knows cancer etiquette. When is it okay to laugh? And if he laughs, or doesn’t, is it because his experience with cancer is dramatically different than my relative inexperience with cancer?

But I also consider the fact that we knew we were listening to an album about cancer. The crowd that night had no idea what was happening. Even so, Louis C.K., the night’s headliner, assessed the set on Twitter this way: 

C.K. knows comedy, but Lance Armstrong knows cancer. And Armstrong walked away from our listening session just as impressed. He was clearly moved, and admittedly, a little shell-shocked by what he heard. Immediately after, we launched into Armstrong’s first major interview since his August decision to drop his fight against charges from the U.S. Anti-Doping Agency, a candid conversation about the crossroads of comedy and cancer, the role of humor in healing, and what goes through the minds of the just-diagnosed.

From the moment Tig Notaro left the club, people were describing her performance as “brave.”  Something like 24 hours earlier she got a life-changing diagnosis. There can’t be a lot of precedent for someone telling their cancer story to a roomful of people so quickly.
It’s incredibly brave. It was this weird collision of her being totally candid, and open and honest and an audience that thought they were coming to a comedy show and didn’t know quite what to think or how to react. And pretty far into it, a lot of them still seemed to think it was an act. But, to me, that’s all she was doing–telling her story, detail by detail.

I imagine you talk to people all the time who just received that kind of news. Take me through what someone is thinking that day.
For most people, that’s the scariest, most humbling, freakiest moment of your life. Everything flashes before you. And I guess the natural reaction is, ‘I’m going to die.’ Even in situations where doctors are confident that you’ve caught it early, people still dwell on, ‘Oh shit. I’m not going to live.’ That leads to a whole host of other questions: What’s treatment going to be like? What’s surgery going to be like? What is chemotherapy? What’s radiation? How’s this going to affect my home life? How does this affect my professional life? It very quickly becomes a massive, scary list of questions.

And nobody can ask, let alone, answer those questions in 24 hours, right?
Nobody is prepared for that, unless they’ve been through it before and it’s a secondary cancer or relapse. You can’t process it that quickly. That’s something we’re really working hard on at Livestrong–to empower people as quickly as possible. When I was diagnosed in 1996 you had no way to really know what to expect. Fortunately, I got some great advice early on, right away, like to bank sperm so you can have kids later. Back then the process of learning about the disease took a long time. Still does.

I think it’s debatable whether this is truly a comedy album, but it raises the bigger issue of comedy and cancer. Can it be done? Especially for someone with a reputation for intensity, you’ve always seemed able to make light of your situation.
Sixteen years later, we try to have fun with it. In my situation, it’s easy to look at me and say, ‘Oh man, dude has testicular cancer and has one ball.’ Who f-cking cares? It hasn’t affected my life at all to have one ball. Sure, it might be a punch line for some people. But I’ve tried to take it and say, ‘Let’s have fun with it.’ I have a coffee shop called Juan Pelota. And at speaking engagements, I regularly tell the story of the birth of the yellow wristband. Nike initially made the bands years before and called them Ballers. The day they came to us and said they had an idea to ‘take a Baller…’, I stopped the conversation and jokingly said, ‘Wait. That’s not f-cking funny.’ People always laugh at that story. They’re like, ‘All right, this guy is cool with it. It’s not a unspeakable thing.’ Shit. I’d rather be alive with one than dead with two.

The album has a couple of funny lines. But generally she’s just telling her story.
That’s just it. She was just telling her story. People were chuckling along some, so it felt a little like stand-up, but, to me, I just heard a person sharing their experience.

By the end, she’s way more positive than when it started. She seems to have gotten to a place of confidence about her future very quickly. That has to be uncommon, right?
There are plenty of people that are given zero chance to live and every day until the day they die they say they believe they’re going to make it. That’s the right way to think. Maybe that’s just the way of human beings or maybe that’s just something friends and family, doctors, and nurses instill in them. There are also situations we simply can’t fix under any circumstances. There aren’t necessarily miracles out there. But I’ve never heard anybody say, “I’m not going to make it.’ Maybe at the very end, after the doctors have tried everything and you’ve bounced around from therapy from therapy. At that point, it’s healthy to say, ‘I did everything I could.’ That’s the place to be if you’re not going to make it. You want to know you did everything you could. You want to know you didn’t give up.

She’s talking very openly about breast cancer, which in this day and age, doesn’t seem that taboo. But there are still places in the world that’s not acceptable, where they think it’s your fault.
Everybody here in the United States is very aware of the disease. But there are parts of the world–whether it’s India, Mexico or Africa–where there is a real stigma around it. They might think it’s contagious or maybe you got it because of something you did in a previous life.

I’ve also heard you say that women brave enough to talk about breast cancer paved the way for someone like you to talk about testicular cancer.
Absolutely. We all owe a great deal to the women who came together in the breast cancer movement, mobilized and decided ‘F-ck it. I’m going to talk about my breasts. I’m going to talk about my cancer without embarrassment.’ Those women paved the way for men. That shouldn’t be a surprise because women have historically paved the way for a bunch of dumbass guys on a bunch of different fronts. Whether it’s young men with testicular cancer, older men with prostate cancer, anybody with colon cancer. Without those women, it would be very different. Even in 1996, when I was diagnosed, I was literally like, ‘F-ck. How am I going to tell the world I have testicular cancer?’

Did you think about creating some kind of cover story?
No. I hadn’t won a Tour De France, but my career was far enough along that I never could have pulled it off. But there are still times when you overhear things. I was at an Austin restaurant not long ago, in the bathroom taking a piss. The bathroom is right by the kitchen and I could hear the people in there talking. One of them says, ‘Lance Armstrong is in here tonight.’ And the other one says. ‘Did you ask him if you could rub his testicle?’ They’re back there joking it up. And I don’t have any problem with that. Part of me wanted to play along and walk in the kitchen with my ball out.

Plus, sixteen years later you’ve heard every ball joke there is.
Sure. Every one. And I’ll admit, in late-1996 and 1997 that kind of thing would have bothered me. But now it’s different. It’s worked out okay for me.

The way it’s worked out, you’re the cancer athlete. Does Tig Notaro run the risk of being the cancer comedian?
Melissa Etheridge was the cancer musician for a little while. Christina Applegate was the cancer actress. If [TIg] continues to tell that story she’ll be known as that. She may also say, ‘Look, I told the story. I’m happy to say I’m a cancer survivor. I’m not going to tell it every time.’ Neither approach is right or wrong. That was my whole deal. I could be very private about it or very public. I chose public. And I’ve continued to be because of the success of the foundation. It’s what we do and it’s expected that I’ll continue to tell my story. That’s my honor. We’ll see how she chooses to talk about in the years to come. Either way, if this thing blows up the way it could and should, it’ll have a serious impact on people with cancer and cancer survivors. It’ll be very helpful for people. She’s done her part.

I wonder if this is a different listening experience for a cancer survivor. I wonder if you experienced that day–the day of diagnosis–if it comes off differently. I could see cancer survivors really rallying around it in a way that people who haven’t had cancer might not.
We–and when I say ‘we’, I mean cancer survivors–tend to rally around these stories. This community that I’m a part of loves success stories. What Louis C.K. said about that night in his tweet is huge. It’s not for nothing.

The one thing that seems not have changed for you, especially with all the drama of that last few months, is that cancer survivors have stuck by you and had your back.
No doubt. No doubt.

Did you worry about whether they’d be there for you?
I don’t worry about any of that stuff. I’m going to continue to do what I think is right for my friends, family, and foundation. It’ll sort itself out. Cancer survivors have been unwavering. They don’t even necessarily care about sports. The sporting part was almost a footnote for them. To them, the birth and success of Livestrong is a hundredfold what one Tour was. The Tours made the foundation possible, made it bigger, gave it momentum, launched the yellow band, and gave us the funding we needed to grow. We wouldn’t be here without it. But that’s over. And now we have to go out and do our job as long as it’s needed. And we’re not leaving. We’re getting stronger. We’re getting bigger. And I think we’re becoming more effective. Those people know it. They see it. Yeah, there are people out there that say, ‘Livestrong is bullshit. It’s just a cover for him and his ego.’ I’ll tell you what, if you step foot in the Austin office, if you come on the road with us and do the stuff we’re doing around the world, you realize real quick that we’re as legit as they come. And we’re not going away.

Livestrong is largely about talking about cancer education. If a comedy album gets people talking and thinking about cancer, that’s a good thing, right?
To me, the album is more about awareness than education. For us, education, navigation, answering the questions I spoke about earlier, are the pillars of our program. This will definitely be an awareness piece though. People are going to hear and it, say ‘Holy shit.’ Personally, I’ve never heard cancer talked about quite like this.

Ultimately, is there something about someone with cancer or a cancer survivor telling her story that’s healing in itself?
Not for everybody. But I do think there’s something therapeutic about it. But people like to share their story. It’s what I hear all the time. People always ask, ‘What do you say to those people?’ I don’t say anything. I just listen. They want to talk. They want to say, ‘This is what’s going on with me. These are my options.’ Very few people call and say, ‘What did you eat? How much did you sleep? Tell me the secret.’ They all just want to tell their story. But more importantly, they want to be heard. And some people don’t say anything. Ever. And that’s okay too.

Is that the weirdest part of being you? Everywhere you go people must want to tell you their cancer story.
I’m pretty comfortable with it now. It’s not every five minutes. You know certain places, certain events, it’s all you’re going to hear, so you’re prepared for that. But as soon as you leave the event and go to dinner with your friends it’s not something that comes up.  We never talk about it. Sometimes it’s nice not to talk about it.