Burden of Truth
By Dominique Jackson
I wasn’t surprised to learn from a geneticist that my
breasts were potential time bombs. Buy why was I, like so many other women, so
reluctant to silence the ticking?
So, you see, surgery to remove the breast tissue would reduce your risk of
developing cancer by 90 percent.” She drew a wide circle two or three times
around the number, written on a notepad now covered with scribbled statistics,
and glanced up expectantly. She looked absurdly young. Could she really be a
qualified genetic counselor? She wasn’t even wearing a white coat. “But,” I
stammered, dazed and emotional after an hour detailing my entire family
history, “what happens if I decide not to take the test?” She gave me a wry
smile, and I thought I heard her sigh. “Well,” she frowned. “Surely you
understand it’s cancer we’re talking about here?”
As I walked back through the maze of hospital corridors, I felt a familiar
indignation welling up. Who the hell was she to lecture me about this disease?
I got into my car and, with the motor running, just sat there shaking in the
driver’s seat, railing at the smug counselor, at my defective genetic heritage,
at all the aunts and ancestors who had handed it down to me. And then I began
weeping for my mother.
Breast cancer has been the sinister thread running through my life for almost
as long as I can remember—at least since I was 6 and my brother, Rory, was 3,
when our parents explained that Mommy had found a bad lump and had to have an
operation. When I was 12, she finally succumbed. For quite a while after that,
the threat would lie dormant until I’d hear about a tragic celebrity struggle
with the disease—Linda McCartney, Kylie Minogue—or some girlfriend’s
fund-raising effort. Every time, my mother’s traumatic treatments would flash
to mind: the five-inch rectangular burn on her back from experimental
radiotherapy, the scar across her shaved head from when they removed her
pituitary gland. But soon enough, I’d be back to nurturing the fantasy that
breast cancer was something that happened to other people.
Yes, I went regularly for the ritual indignity of a mammogram. I made clumsy
attempts to check my breasts after every period and felt I had done my bit for
the next 28 days. But then, in 2004, the beast jumped back to center stage. My
cousin Sarah, six years younger than I am, found a lump while breast-feeding
her new daughter.
It was an aggressive cancer, and the prognosis was not great. Her doctors had
also identified a faulty gene—BRCA2—which meant that anyone in Sarah’s family,
including third-degree relatives like me, was also at risk.
There are a dozen close female cousins on Mom’s side of the family, all aged
between 38 and 48. At 44, I’m pretty much in the middle. The news put the
family grapevine into overdrive: Michèle was definitely taking the test to see
if she had the mutation; Jill wouldn’t, but would make damn sure her daughters
did. Even Chris, proud father of teenage girls, bravely went for a test
himself: positive. Me? I couldn’t decide. On one hand, I have always presumed
I’d inherited some genetic disposition from my mom. On the other, it was
possible that I had somehow escaped scotfree: To date, of my eight cousins who
have been tested, four are positive and four are negative.
Undoubtedly, breast cancer still claims too many victims; it killed my mother,
and in a way, I believe it claimed my younger brother, too: Rory, a mama’s boy
if ever there was one, died 20 years after she did. Officially, it was from a
combination of alcohol, anorexia, and HIV. But my dad and I knew better: It was
slow suicide from grief. I hadn’t managed to save Rory’s life, but was I now
being offered a chance to save my own?
Then one day, I was summoned by my cousin Amanda. Serene, doe-eyed Amanda, with
the huge, cheerful husband and the two adorable daughters. She sat me down,
opened a large envelope, and handed over some papers. “BRCA2 Exon 16
sequencing—Analysis indicates heterozygous for familial mutation
7990—7992delATAinsTT. Relatives of Amanda are at risk. Molecular testing is
available to them.” I tried my usual spiel: “They keep a close eye on me
because of Mom. I’m as aware as I can be. Honest.” She wasn’t buying it. She
was seriously considering a preventive mastectomy. She, too, had lost her
mother when she was little, and she had her girls to consider. Wouldn’t I at
least have another think about getting tested?
And that’s how I ended up sitting opposite the teenage geneticist for my
initial counseling session, discussing relative risk and frighteningly precise
percentages. Stubborn I may be, but stupid I’m not. I can do the math. The
counselor’s preposterous balloons full of big numbers floated around in my
head: If I have the gene, I have as high as an 85-percent chance of getting
cancer; if I get my breasts removed, I cut my risk by 90 percent. She urged me
to take the test.
I didn’t make an appointment, but I did start to type the unthinkable
“prophylactic mastectomy”—into Google with obsessive frequency. I started to
ask myself some tough questions: Would I continue to monitor my risk, take
preventive drugs, or would I bite the bullet, take the test, and—if it came
back positive for BRCA2—have the guts to go under the knife?
That would mean finally addressing the thorny issue of my breasts, after
managing to ignore them for 30 years. They had been an embarrassment since the
summer they appeared, as if by magic, on my bony rib cage. They soon became a
major hazard for any sports and particularly inconvenient for my fanatical
rowing. I was busty enough that my coveted Armani jacket would never look
really chic on me. Maybe losing them would have some benefits? I could get a
smaller, perkier pair.
What about my husband? I was fairly sure I could sell him on the idea of some
sort of enhancement. I had tried more than once to have a serious discussion
with him about the implications of a positive test, but for a long time he
refused to take me seriously, joking about how much bigger he’d like my breasts
But in a rare serious moment, he pledged his support for whatever decision I
might one day make.
The more I looked into prophylactic mastectomies, the more I realized that
tissue removal and reconstruction was not just a question of a couple of
state-of-the-art implants. This was radical, invasive surgery that might entail
using muscle or tissue from my back, thighs, or abdomen. It would almost
certainly mean reconstructed nipples. No way was this an easy option for
someone like me, a woman who can’t even drive past a hospital without
hyperventilating. Shuddering, I thought about all my mother had gone through
and how hopeless I was at summoning up that kind of courage myself.
Maybe, on some level, I have always known that my breasts were a kind of time
bomb. When I was a child, my mom’s new, lopsided chest, with its purple ridge
of stitches and its puckered circle of skin, had been so unexpected, so unreal,
that I couldn’t keep the enormity of it all to myself. I was the 7-year-old
traitor who let her secret out to a friend, who told her mom, who told my mom
that I’d told. I knew I’d let her down. It might have been the permissive
1960s, but back then, nobody proudly exposed their mastectomy scars or their
hairless skulls, or wore pink ribbons. I hope she would agree that we’ve made
progress since then. For the millionth time, I wish I could ask her, “What do
you think I should do?”
I already know what she would’ve done. Her mastectomy was only the first of
many mortifications. I’m not so brave. Whenever I think about taking that test,
I know I will also have to consider surgery, even though it doesn’t reduce my
cancer risk all the way to zero. But I can’t commit, especially since I need to
think beyond the mastectomy. An inherited BRCA mutation also gives women a 16
to 60 percent chance of developing ovarian cancer—a disease that often doesn’t
present itself until it is too late to save your life. But removing the ovaries
and fallopian tubes means instant menopause, and I’m still vaguely hoping to
get some use out of my eggs.
For the time being, I’ve chosen to indulge my semi-blissful ignorance. But I am
taking better care of myself. I am trying to kick the booze after too many
years of enthusiastic self-medication. I do weight-bearing exercise, and I keep
up with the latest thinking on soy isoflavones (may lower risk), green tea (its
antioxidants may protect against cancer), underarm deodorants (not likely to
increase risk), and tamoxifen and raloxifene (drugs that help lower risk in
some women, but not without side effects).
And if no baby happens within a couple of years, well, then it’s time to
seriously explore other options— including taking the test, and maybe even
having the surgery—that might just save my life.