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October 1, 2006

Burden of Truth

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Undoubtedly, breast cancer still claims too many victims; it killed my mother, and in a way, I believe it claimed my younger brother, too: Rory, a mama’s boy if ever there was one, died 20 years after she did. Officially, it was from a combination of alcohol, anorexia, and HIV. But my dad and I knew better: It was slow suicide from grief. I hadn’t managed to save Rory’s life, but was I now being offered a chance to save my own?

Then one day, I was summoned by my cousin Amanda. Serene, doe-eyed Amanda, with the huge, cheerful husband and the two adorable daughters. She sat me down, opened a large envelope, and handed over some papers. “BRCA2 Exon 16 sequencing—Analysis indicates heterozygous for familial mutation 7990—7992delATAinsTT. Relatives of Amanda are at risk. Mole cular testing is available to them.” I tried my usual spiel: “They keep a close eye on me because of Mom. I’m as aware as I can be. Honest.” She wasn’t buying it. She was seriously considering a preventive mastectomy. She, too, had lost her mother when she was little, and she had her girls to consider. Wouldn’t I at least have another think about getting tested? And that’s how I ended up sitting opposite the teenage geneticist for my initial counseling session, discussing relative risk and frighteningly precise percentages. Stubborn I may be, but stupid I’m not. I can do the math. The counselor’s preposterous balloons full of big numbers floated around in my head: If I have the gene, I have as high as an 85-percent chance of getting cancer; if I get my breasts removed, I cut my risk by 90 percent.

She urged me to take the test. I didn’t make an appointment, but I did start to type the unthinkable— “prophylactic mastectomy”—into Google with obsessive frequency. I started to ask myself some tough questions: Would I continue to monitor my risk, take preventive drugs, or would I bite the bullet, take the test, and—if it came back positive for BRCA2—have the guts to go under the knife? That would mean finally addressing the thorny issue of my breasts, after managing to ignore them for 30 years.

They had been an embarrassment since the summer they appeared, as if by magic, on my bony rib cage. They soon became a major hazard for any sports and particularly inconvenient for my fanatical rowing. I was busty enough that my coveted Armani jacket would never look really chic on me. Maybe losing them would have some benefits? I could get a smaller, perkier pair.

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