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October 1, 2006

Burden of Truth

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?

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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.

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