When Breast Cancer Runs in the Family

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At age 43, English author and journalist Sarah Gabriel, was diagnosed with breast cancer. She had two young daughters and a loving partner and while cancer took her mother at a young age, she was determined not to accept her genetic legacy. In her memoir, Eating Pomegranates, Gabriel writes about her fight to survive, stay sane, to protect her young daughters and to stop the BRCA1, the rare and deadly genetic mutation that had caused her cancer, from claiming another victim. Gabriel also sketches a history of breast cancer treatment, from surgery without anaesthetic in the nineteenth century to modern chemical regimes

Gabriel,
now three and a half years out from diagnosis, recounts her experience with this all too common disease. In this installment she recalls receiving the news she has the ‘breast cancer gene’.

When the doctors first told me that I had tested positive for a mutation on the BRCA1 gene, one year before diagnosis, my mind couldn’t take it in.

“We believe this gene is associated with the suppression of tumors, particularly in breast and ovarian tissue,” said the geneticist. “When cells replicate, some carry faulty DNA. If a woman has a mutation of this gene, the mechanism to clear up these faulty cells fails to work properly. This probably accounts for your mother’s death from ovarian cancer at 42.”

This was deeply confusing to me. My mother had had five children, very close together. Her life had not been easy. I think I had always felt that we were responsible for her death. Childcare and domestic drudgery had worn her out. But no, the doctors were telling me a different story.

“These cancers strike younger women. They run in families. It wasn’t until the 1990s that the BRCA genes and their role in the formation of cancer were discovered.”

I was 43 when I learned this, one year older than my mother when she died. It didn’t take a mathematical genius to work out that I was living on borrowed time. “What shall I do?” I said in stark terror. “My children are so little.”

The doctors explained that I had a 60% lifetime chance of developing ovarian cancer, which kills four in five women who get it. I also had an 85% lifetime risk of developing breast cancer.

They brought out a lot of graphs and showed me the pattern of how the cancers struck. A woman might go through her life to her late 30s or early 40s without knowing anything was amiss. And then all of a sudden, there it was, the black line setting off at a sharp sprint: lots of women developing breast and ovarian cancer.

Gravely, respectfully, the doctors explained that the only real way to protect against the ovarian cancer risk was oophorectomy, or removal of the ovaries, since there is still no reliable screening test for it, and it is often detected too late.

As far as I could see, it was a ‘no brainer’. And yet it was still one of the hardest decisions I have ever made. It felt literally ‘against my nature’. Even at the last minute, going down to the operating theater, I wanted to jump off the trolley. But I felt I had no choice. My children were so young, just two and four: I owed it to them to go through with it.

A kind nurse reassured me that she had seen others struggling in a similar situation. “You’re not alone,” she said. “I’ve seen other women going through the same thing. The only way they keep to their decision is by looking at photographs of their children.”

But when, alongside this, the doctors began telling me that my very high risk of breast cancer could also be managed by something called ‘bilateral mastectomy’, my mind went into freefall.

What? Were they seriously suggesting what I thought they were suggesting? What horrific idea was that? Was this some sort of sick joke?

I felt as if I had entered a horror film from which I would never emerge, like a nightmare you are conscious you’re having but can’t wake up from.

“Removal of both breasts reduces the risk of breast cancer by 90%,” they said. “A proportion of women with a BRCA mutation do opt for prophylactic surgery. And there are now a number of surgical ways of rebuilding a breast. Of course, it is a very personal decision.”

But I wasn’t having it. I was getting out of there. They could keep their statistics, their lifetime risks, their recently published papers on the increased survival of women who opted for surgery. They could keep their graphs about when the cancers struck in women with mutations of the BRCA gene and their terrifying euphemisms about ‘rebuilding a breast’.

How could you ‘rebuild’ a breast? It was a contradiction in terms, like taking a plaster cast of a humming bird, or writing a computer formula for a kiss.

No, no, no. I was off. I wanted no more of their world. I couldn’t even cope with what they had given me of it.

So I closed the case on mastectomy. I went about my business, which was hard enough. In summer 2005, there was oophorectomy, followed by crash menopause, with its welter of unwelcome symptoms. I stabilized on HRT, and got on with looking after my children. And then diagnosis forced the whole thing open again, in March 2006.

I couldn’t ignore the risk from breast cancer after all. It was real, not a fiction. The doctors were not sharpening their scalpels just to frighten me. They were sharpening their scalpels to try and save my life.

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