Time For One Thing: A positive side effect

The risk of inheriting the gene that killed my mother had once frightened me into paralysis. But my relationship with my breast surgeon has helped me manage my fear.


Joan Walsh
October 14, 1997 11:00PM (UTC)

Just by coincidence,
I usually see my breast surgeon in October, National Breast Cancer Awareness month, but I saw her early this year because she's on maternity leave again. After my visit, I ran into a friend. When I told her where I was, she suddenly looked alarmed. "I didn't
know you had breast ... problems," she said, concerned.

"I don't!" I jumped to reassure her. Then I was suddenly
tongue-tied: So why do I have a breast surgeon? I see her two or three
times a year, and I think of her as part of my crew, like my therapist, my
hair stylist, the woman who does my nails. But she's not exactly a yuppie
indulgence.

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Five years ago a genetic counselor told me I was at "elevated risk"
for breast cancer. My mother died of it at 45; her mother had been struck
by the disease in her 40s but survived. Since both women developed breast cancer at a relatively young age, they likely had a
genetic problem that allowed a later "trigger" -- such as diet, hormones, chemicals -- to bring on the disease earlier
than in a woman without a genetic predisposition.

My own lifetime risk of breast cancer, based on epidemiological
studies, was estimated at one in four, compared to the "average" woman's
risk of one in nine. I was left with a choice: preventive mastectomy,
extreme vigilance or denial.

I briefly opted for denial. The confusion over what to do was
paralyzing. Preventive mastectomy seemed barbaric. I like my breasts and I
didn't want to lose them to a disease I may never get. Besides, surgery
can't remove everything, and sometimes cancer shows up in the tiny bit of
breast tissue that's left behind. That seemed just my luck -- I'd lose my
breasts but wind up with cancer of the tissue around my collarbone.

The "extreme vigilance" option wasn't terribly reassuring, either.
The news of my elevated risk coincided with a sudden surge in breast cancer
activism, as advocates began to protest the lack of progress on prevention,
detection and treatment of the disease. Suddenly, activists like Dr. Susan
Love were questioning the utility of mammograms for women under 50, whose
dense breast tissue makes it harder to spot a small tumor. Experts began
to debate whether annual mammograms saved lives or created a false sense
of security in younger women, causing them to neglect to examine their own
breasts.

Not that breast self-exam was a much better option, the advocates
noted: By the time a breast tumor is large enough to feel with your
fingers, it has often already spread. And with treatment options still
limited to "slash, burn and poison" -- surgery, radiation and chemotherapy
-- death rates were remaining high, despite earlier detection. I admired
the new activism, which was intended to goad the medical establishment into
action. But it also, for a time, intimidated women like me into not acting.

That's when I met my breast surgeon. On our first visit, she
quizzed me about my family history of breast cancer -- and about my
daughter, my writing and mixing motherhood with a career. Roughly my age,
she wanted to start a family, but worried about how it would mix with her
practice. Our conversation tacked back and forth between cancer research,
motherhood and men, and I walked away with a plan of action: She'd examine
me manually every four to six months, and I'd get a mammogram once a year.
Mammograms work for me: My breasts happen to be less dense than those of most women
my age, or as my radiology technician put it, "You have the breasts of a
55-year-old woman." I wouldn't have imagined thrilling to those words 10
years ago, but in this context they were the nicest thing anyone could say
about my breasts.

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That was almost five years ago. In those years my surgeon has had
two babies; I've gotten divorced, changed jobs as well as boyfriends. We have a relationship. When we visit, she asks me for advice about
childbirth, child care and preschool. I ask her if I should think again
about preventive mastectomy (she says no), or worry about a tiny pimple on
my chest (she pronounced it "a big nothing"), or continue dating someone
who travels more than I do (she left that one up to me).

Her office calls when it's time for my appointment. They call
again if I don't call back. I feel too guilty to let much time pass
between visits, and I actually look forward to seeing her. She maintains
my sanity, and indulges my periodic paranoia. Once when I became convinced
that a small cyst below my left breast was more than "a big nothing," she
squeezed me in at the end of her long day, removed it and sent it to
pathology just to reassure me. Of course, it was a big nothing. But I
didn't have to wait weeks to get that confirmed.

Yet I still got tongue-tied when I tried to explain why I have a
breast surgeon. Sometimes I feel like it's morbid to have a doctor ready
to treat a disease I may never have. On the other hand, breast cancer
already is my disease. Its assault on my mother, who had her mastectomy
when I was 12, shaped me profoundly. So did her culturally bred sense that
she had a shameful illness -- both cancer and breasts were something you
whispered about -- which kept us both from getting the emotional help we
needed. This society draws a cruel line between the well and the sick, and
the stigma of serious illness is part of its pain. I feel I know a little
of the terrain on the other side of the line now, and that helps me,
practically and psychologically.

My fear has become manageable. I've limited my worrying about
getting breast cancer to five minutes before my appointments. Then my
surgeon walks in, and we chat excitedly, maybe a little maniacally, the
whole time she examines my breasts. I keep up my end of the conversation
-- my daughter, my writing, my boyfriend -- while searching her face for
clues: Did she find anything? Am I all right? She helps me up off the
table and tells me I'm perfect. We finish up our conversation and make
plans for our next visit, like busy girlfriends penciling in their next
lunch date.

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Joan Walsh

Joan Walsh is the author of "What's the Matter With White People: Finding Our Way in the Next America."

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