Here’s how I got to lumpectomy + radiation. It’s all about risk. I have a family history of cancer: maternal grandmother with breast, colon, skin, and cervical cancer, two aunts with breast cancer, and an uncle with esophageal cancer. This collection of cancers puts me in the high risk category, even though my mother has not had breast cancer and is negative for the two most common genetic mutations linked to breast cancer: BRCA1 and 2. I also do not have a sister with breast cancer, which lowers my risk, but then again, I don’t have a sister at all, so I’m not sure how my non-sister actually factors in. I should say that my mother is the youngest of eight. She had hairy cell leukemia, now in remission. There’s an awful lot of cancer in her family.
My surgeon looked at all this history and urged genetic testing. He wanted me to, as much as possible, work with facts to determine my personal level of risk, which would determine whether I would havelumpectomy + radiation, or a prophylactic double mastectomy. The ultimate goal is to bring down my risk of recurrence and eliminate the possibility of having the cancer spread to somewhere else in my body. But I also don’t want to undergo major surgery—which a double mastectomy is—unless I absolutely need it.
The genetic test results came back early and the news was all good: thirty-four cancer-related genetic mutations were tested and I was negative for all of them. 34 up, 34 down—I’m clear.
This is huge. It changed my whole risk profile, putting me at normal risk for a recurrence of cancer, not higher risk due to heredity. Normal risk. And normal risk to me suggested normal treatment, standard treatment, i.e. lumpectomy and not mastectomy.
But the right choice for me only fully became clear after I imagined my choices in terms of the game show Let’s Make a Deal. Door number 1: Pay Now with double mastectomy. Door number 2: Pay Later with disease recurrence necessitating a double mastectomy. But then there was also door number 3: Don’t Pay At All or treat this breast cancer and never have breast cancer again. The genetic counselor told me that over twenty years I have an 85% chance of getting door number 3.
Of course, there are few sure things in life. At any point I could end up at Door number 2. I could have a series of false positives and worrisome biopsies that make me wish I’d picked Door number 1. But I’m putting my faith in Door Number 3: Don’t Pay At All. It helps to know that the odds are now very concretely in my favor.