Luckily, I’m not too late to put my two cents in during Breast Cancer Awareness Month. Like so many of us, cancer has touched my life – specifically breast and ovarian cancers. My family has both victims and survivors, and a genetic link is to blame. In my mind, knowing about my own risk was empowering, but I know not everyone agrees. I was lucky enough to find FORCE (Facing Our Risk of Cancer Empowered) and get support and information. But, as empowered as I feel for myself, I also feel guilt for the possibility to pass this on to my daughters. It is a common mix of emotions, but tough to deal with nonetheless.
In October, 2005, I wrote the following essay, and I’d like to reprint it here now. Whether or not cancer has touched your life, take this opportunity to count your blessings and hug your loved ones.
I have made many promises throughout my life. It’s unlikely I intended to keep them all, but I’d like to think that I tried. To be honest, I never gave my promises much thought until the day my older daughter started asking me to make promises to her. I promised that I would make her a sandwich on her favorite potato bread. I promised that I would let her bring her stuffed kitty to the grocery store. I promised that I would play our lullaby on the piano each night before she and her sister fell asleep. These were small promises, but they meant so much to her. She would harp on the fact that you should never make a promise you can’t keep. She truly believed that, and I had no problem upholding my end. Until the day she came to me and said, “Mommy, promise me you won’t die.” Wow. What do you say to that?
My knee-jerk reaction was to assure her that I wasn’t going to die. But living in this age of awareness at how random death can be, how senseless, how quick and unexpected, this promise suddenly meant more. Knowing that my daughter wouldn’t accept an impossible or half-hearted promise made the answer that much more difficult.
Her request for this weighty promise came not long after a good friend of hers lost her father. My daughter is quite intuitive, and realized what the loss meant for her friend. She told me how sad she was, because her friend’s father would never be able to read a bedtime story to his daughter again. And then she cried. From then on, death was on her mind a lot. So when she asked me to promise that I would be around always, I knew the answer mattered, and I knew I had to believe the answer I gave her with all my heart.
What I came up with was a series of reassurances and carefully crafted sentences. I assured her that I had no intention of going anywhere. I assured her that I want to be around for a long time too, so I try to eat right, exercise, and do all the right things to stay as healthy as possible. I believed it, and she accepted it. Then I got some news that would cause me to give my daughter’s question even wore weight.
My mother was diagnosed with breast cancer.
Since my mother, her mother, and her mother’s sister all had breast cancer, and her family fit the profile for a certain genetic mutation, my mother decided to have genetic testing.
In the search for a cure for cancer, researchers discovered genetic mutations they call BRCA1 and BRCA 2. A woman with a BRCA mutation has a greatly increased risk of developing both breast and ovarian cancer — much higher than the general population. The mutations are autosomal dominant, meaning it only takes one gene to pass them on, so a child has a 50% chance of having the same mutation as his or her parent.
When I learned that my mother’s results came back positive for the BRCA2 mutation, I knew I had to get tested myself.
When I was a teenager, I learned that my grandmother and great-aunt both had breast cancer, and I always assumed that I too would get breast cancer some day. I used to joke that my 40th birthday present to myself would be a double mastectomy and complete hysterectomy so I could avoid the cancer that seemed to plague my family. But when my mother’s results came back positive for BRCA2, my little joke was no longer remotely humorous. When I went to get the genetic test, I knew I would test positive. Hadn’t I always assumed breast cancer was an inevitable part of my life? Even so, a part of me still held out hope for a negative test result.
Several weeks after taking the test, I was called into the doctor’s office to receive the results. As a matter of policy, the results are only given in person, and in the presence of a genetic counselor. I walked in knowing I would be positive. So, when I received confirmation that yes, I was indeed positive for BRCA2, I was surprised that I broke down into tears. For some reason, even though I always assumed breast cancer was in my future, finding out that it was in my genes, in every cell in my body, was like a kick to my stomach. And worst of all, I realized that by having this mutation, it means that my children each have a 50% chance of having this same horrid gene as well.
“Mommy, promise me you won’t die.”
Those words ran around in my head every hour of every day after learning I was positive for BRCA2. And they were made even more painful mixed with the guilt I felt knowing that I may have passed along a cancer gene to my children. My daughters.
I desperately wanted to wake up from this nightmare. I wanted to get a call saying, “Oops, we’re sorry we gave you the wrong results. Actually, your genes are the best we’ve ever seen. A medical miracle.” But of course, that didn’t happen
I met with several specialists: oncologists, genetic counselors, and gynecologic oncologists, and I learned what options were out there for me. Most importantly, I learned to view my knowledge of my genetic status as power. By knowing that I was likely to get cancer eventually, I could do something about it now. Preemptive strike, so to speak. A few months after getting the news, I scheduled a bilateral oophrectomy (removal of both ovaries and Fallopian tubes). Now, on top of everything, I had to prepare my daughter for my surgery. Interestingly, that is exactly what helped me find the answer to her question.
“Mommy, promise me you won’t die.”
I will never say to her, “I promise honey, I won’t die.” I couldn’t do that, and she wouldn’t believe me. No one can keep that promise. I will respond to her by telling her that I am taking care of myself because I want to be around for a long, long time, and for me, it means having surgeries to remove parts of my body that have a good chance of getting very sick. I will tell her I am doing everything in my power to stick around. I will even tell her I have no plans to go anywhere for a long, long time. But I will never make a promise to her that I cannot guarantee I will be able to keep. And maybe she’ll grow up stronger because of it. Maybe not. But I know, in case of the unexpected, she will never have the added heartbreak of a broken promise.