Cancer has always been a part of my life.
From a very young age, I knew of my family history of cancer. My maternal grandmother was diagnosed with breast cancer in her early 30s, and succumbed to it at age 43. Her aunts, nieces, cousins and her own mother all had breast cancer. It is startling to look at her family tree and see that every female member passed away from breast cancer, most of them before reaching age 50. So when my parents sat us down when I was in middle school to tell us of my mother’s diagnosis, I wasn’t surprised. I remember vividly her treatments and surgery, and ultimately her recovery — becoming the first person in the family to survive cancer.
Growing up, I was certain that I would also get cancer at some point. So I was also not surprised when, in the summer of 2007, I tested positive for a genetic mutation called BRCA1. It is often referred to as the “breast cancer gene,” and I inherited the mutation from my mother, who undoubtedly inherited it from her mother. The test results provided some comfort, a logical reason for why generations of women in my family were struck by cancer. It also meant that I have an almost certain chance of developing breast cancer, and a highly increased chance of developing ovarian cancer.
They say that knowledge is power. Along with knowledge, though, there are hard decisions. After receiving my test results, I was connected with a fantastic team of medical professionals. The education and help I received from my genetic counselor (Wendy McKinnon), breast surgeon (Mary Stanley), from my oncologic gynecologist (Kym Boyman), and many others were the key to my understanding what this really meant and what my options were.
My choices were clear. I could opt for increased surveillance: multiple doctors’ visits, mammograms, MRIs and ultrasounds a year, with the hope that if anything is detected, it will be early enough.
The other option is to attack first. Many women with BRCA mutations choose to have a prophylactic double mastectomy, removing their otherwise healthy breasts, to stave off cancer. They often choose an oopherectomy as well, the removal of healthy ovaries, to avoid being struck by ovarian cancer. This may seem like is a radical choice, but studies have shown that these surgeries can reduce a woman’s risk of cancer by upwards of 90%.
In actuality, the choices have been clear only on paper. The truth is that it is an almost impossible choice to make. My team of medical professionals has given me much information, but they can’t tell me what to do. My partner, with tremendous support and patience, has listened to me talk about it endlessly, but he can’t make the decision for me. I have not ruled out prophylactic surgery. However, at this point in my life, increased surveillance is the path I have chosen, with the hope that if anything is identified, it will be in its earliest and most treatable stage. The realization that not many women my age are facing their own mortality as squarely as I am is sometimes a lonely one.
However, I have knowledge that generations of women before me did not. I know what my risk status is. I have access to a higher level of screening. And no matter how difficult the choice is to make, I have the option of making a choice when they did not. For that, I consider myself fortunate.
However, a woman need not be at high risk to be proactive with her health, nor should she wait until she is older to start monitoring her body. This is the message that I want to share with women everywhere: Being proactive with one’s health is something we should all aspire to. If I have learned anything , it’s that women should be taught at a young age to pay attention to their bodies, know their family history, and to do self breast exams. With that level of awareness, they will be more likely to detect cancer at an early, and treatable, stage.
Angela Smith is the Vermont Ambassador for Bright Pink, a national organization that focuses on prevention and early detection of breast and ovarian cancer. Bright Pink Vermont hosts outreach and educational events for women interested in learning more about their risk status, and what they can do to be proactive with their health.
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