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October 1, 2006

Burden of Truth

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What about my husband? I was fairly sure I could sell him on the idea of some sort of enhancement. I had tried more than once to have a serious discussion with him about the implications of a positive test, but for a long time he refused to take me seriously, joking about how much bigger he'd like my breasts to be.

But in a rare serious moment, he pledged his support for whatever decision I might one day make.

The more I looked into prophylactic mastectomies, the more I realized that tissue removal and reconstruction was not just a question of a couple of state-of-the-art implants. This was radical, invasive surgery that might entail using muscle or tissue from my back, thighs, or abdomen. It would almost certainly mean reconstructed nipples. No way was this an easy option for someone like me, a woman who can't even drive past a hospital without hyperventilating. Shuddering, I thought about all my mother had gone through and how hopeless I was at summoning up that kind of courage myself.

Maybe, on some level, I have always known that my breasts were a kind of time bomb. When I was a child, my mom's new, lopsided chest, with its purple ridge of stitches and its puckered circle of skin, had been so unexpected, so unreal, that I couldn't keep the enormity of it all to myself. I was the 7-year-old traitor who let her secret out to a friend, who told her mom, who told my mom that I'd told. I knew I'd let her down. It might have been the permissive 1960s, but back then, nobody proudly exposed their mastectomy scars or their hairless skulls, or wore pink ribbons. I hope she would agree that we've made progress since then. For the millionth time, I wish I could ask her, "What do you think I should do?"

I already know what she would've done. Her mastectomy was only the first of many mortifications. I'm not so brave. Whenever I think about taking that test, I know I will also have to consider surgery, even though it doesn't reduce my cancer risk all the way to zero. But I can't commit, especially since I need to think beyond the mastectomy. An inherited BRCA mutation also gives women a 16 to 60 percent chance of developing ovarian cancer--a disease that often doesn't present itself until it is too late to save your life. But removing the ovaries and fallopian tubes means instant menopause, and I'm still vaguely hoping to get some use out of my eggs.

For the time being, I've chosen to indulge my semi-blissful ignorance. But I am taking better care of myself. I am trying to kick the booze after too many years of enthusiastic self-medication. I do weight-bearing exercise, and I keep up with the latest thinking on soy isoflavones (may lower risk), green tea (its antioxidants may protect against cancer), underarm deodorants (not likely to increase risk), and tamoxifen and raloxifene (drugs that help lower risk in some women, but not without side effects).

And if no baby happens within a couple of years, well, then it's time to seriously explore other options-- including taking the test, and maybe even having the surgery--that might just save my life.

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