Close to Home: Making the most of chances my mom and cousin didn’t have

My mom had just celebrated her 56th birthday when she died from complications of an aggressive breast cancer. It was 1991, and I remember thinking, at age 31, “Well, at least she lived a full life.” Oh, the arrogance of youth. Two years ago, as I celebrated my own 56th birthday, I thought of all the things that I hadn't done yet (walking along the Seine, riding a bike through the New England leaves, watching the Northern Lights) and wondered about the items Mom left unchecked on her own bucket list.

In 1997, my cousin, Teri, was diagnosed with breast cancer and died less than two years later, at age 39. Teri left behind three children between the ages of 2 and 12. Teri and I had been almost as close as sisters growing up. It is heartbreaking to imagine all the things that she isn't around to experience.

Fortunately for me, and millions of other women, in the 14 years between Teri's death and my own diagnosis, breast cancer prognosis and treatment changed dramatically.

For one thing, genetic testing for women with a bad family history provides a window (albeit foggy) into the future.

While the cancer diagnosis came out of the blue for both mom and Teri, I was fortunate to have a heads-up. In 2008, when one of my three sisters was diagnosed with breast cancer, she discovered that she had the BRCA 1 gene mutation. Her test results prompted me, my siblings and Teri's two sisters to be genetically tested. I was positive for BRCA 1, as was a cousin.

I received genetic counseling to understand the risks and options, and I decided to have my ovaries removed. (The chances of developing ovarian cancer are much higher for women with BRCA1.) I also received aggressive breast cancer screening, alternating between mammograms and MRIs every six months. Ironically, in 2013, as I was seriously contemplating a prophylactic mastectomy, my luck ran out. I found a small lump that turned out to be cancerous.

Imagine if my mom and cousin had known about their risk. They might have stopped smoking, received frequent mammograms, and Teri might have been taken seriously when she found a lump, rather than being sent home without follow-up, since she was “too young” to have cancer.

A second difference between the 1990s and today became apparent when the lump that I found was biopsied: As is common for women with BRCA 1, the tumor tested negative for progesterone, estrogen and human epidermal growth factor (what's known as “triple negative” breast cancer). Breast cancers are no longer grouped into one large category, but are identified by characteristics that help guide treatment and follow-up. I can't help but think mom and Teri would have benefited if their doctors had more precise information about what they were dealing with.

From the patient perspective, probably the best advancement over the past couple of decades is the drugs - both those used to treat the cancer and those to reduce the side effects from treatment. I remember my poor mother (who otherwise had an iron gut) becoming literally sick to her stomach just by walking into the chemotherapy treatment center.

My experience was totally different. I actually gained weight during the 12 weeks of chemotherapy, thanks to effective anti-nausea drugs (and the endless stream of meals supplied by family and friends). In fact, the drugs were so good that I was able to follow my sister's model of continuing to run, cycle and work full-time.

This autumn marks five years since I finished chemotherapy for breast cancer. According to my oncologist, I'm pretty much “cured.” What's astonishing to me is that I'm not astonished by this good news. Rather than the death sentence that it used to be, breast cancer now seems to be a relatively treatable disease for the majority of women. Clearly, there are still exceptions. Age, ethnicity, income, access to health care, overall health and luck all play a role diagnosis, treatment and how we respond.

I'm fortunate to be a healthy, middle-income, middle-aged woman with good insurance and the constitution of a horse, who lives in a community with great doctors and access to major research hospitals. So, unlike my mom, I have the luxury of working on that bucket list. Paris, anyone?

Ann DuBay of Healdsburg is participating on a panel, with Charles Elboim, a surgeon specializing in breast cancer, and Kathleen Mott, an advanced practice nurse in genetics, on Oct. 21. The “Jews, Genes and Cancer: How Science Could Change (or Save!) Your Life” discussion is free. Go to www.shomreitorah.org for information and to register.

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