I just passed my second Father’s Day without my Dad. He died November 2, 2009 after facing down prostate cancer and then renal failure. Sadly, I was not at his side when he passed away peacefully in his sleep before dawn. I had just completed my second breast cancer surgery within six weeks and was still in New York with a drain attached to the left side of my body.
I adored my father. We had a dual relationship: father-daughter and business advisor-business woman. Way too frequently the two relationships collided On one phone call we would discuss a tax issue, payroll or another business matter; the next he would share gossip from my hometown Chattanooga, tell me a joke or read me a chapter of the latest book he was writing about the Civil War. We’d fight over business and then share funny stories. He stood up for me when the banks turned me down for my first business loan and stood by me when heart was crushed over a passing love affair.
We were both alike in so many ways. I inherited his business sense and his work ethic. I inherited his sensitive skin, his square shoulders and his mischievous grin (or so people tell me). We shared a love for great wines, far flung travel and the brilliant ray of light who is my mother, whom he called Sunny.
We also shared a “cancer gene” mutation called BRCA2. There is also a BRCA1 gene. They both translate to cancer but with different mutations and associated cancer risks After I was diagnosed with breast cancer I had to fill out a zillion forms about my family health history. I realized I didn’t know much about my family’s health history; who thinks about these things? Thankfully, my mother seems to know everything about everyone in my family.
“Breast cancer is not in my family,” I told my doctors. “I am the chosen one, unique and special.”
But my father had prostate cancer and a bout with melanoma. And his mother had pancreatic cancer as did my paternal great grand mother I later found out when I researched the family health tree. And these cancers can also share the BRAC2 gene. Also, 1 out of 40 individuals whose background comes from the Ashkenazi Jewish population has inherited one of three founder mutations in BRCA1 and BRCA2. For the record, the information I am providing comes straight from my “Clinical Genetics Service Follow Up Report” from Memorial Hospital for Cancer and Allied Diseases in New York City (aka “Sloan Kettering”). I am a “card carrying member” of MSKCC. Really, they give you a card when you enroll.
My doctors suggested that I undergo genetic testing, and I did not give it a second thought. It wasn’t like I was at risk for getting cancer. I already had cancer. I just did not understand “why me?” when no one else in my immediate family had breast cancer I assumed the cancer was the result of too much stress and being a bit overweight. But realizing that there may have been a genetic influence would explain more.
The test is simple. A nurse practitioner pricks your finger, and your blood is tested. First you fill out a zillion more forms, and counselors sit down and talk you through everything. It is all very thorough and not intimidating.
So what does it all mean? Well, for me who tested postive for the BRAC2 gene, it meant I had a 27% chance of getting ovarian cancer by the time I hit age 70. So, I decided to have my ovaries and Fallopian tubes removed, a prophylactic surgery called an “oophorectomy.” The name sounds like you feel post-surgery – “Oooph!” If my cancer had only been in one breast, the risk of a recurrence in the second breast could be as high as 25-30% barring various factors. For me that was a non-issue; both my breasts had cancer and needed to go.
As for those other nasty cancers in the BRCA2 family, pancreatic, melanoma and prostate (the latter not being terribly important for my case), I can watch my exposure to sun but that is about it with skin cancer. You can try to eat better, exercise more and lessen your stress level. These are your best precautions. There are “surveillance programs” you can enter, and you can volunteer to be monitored. Otherwise you live your life, perhaps with more purpose, or perhaps not.
Some people may be afraid of undergoing genetic testing, especially if you have not been diagnosed with any of these cancers, are of child bearing age or have children. Is not knowing better or worse? For some, knowing puts a cloud of fear in their minds. And how will it impact their children? Could it affect their health insurance? The specter of getting cancer puts the fear in everyone; the reality of having it puts you in survivor mode and teaches you to face your worst fear head on.
I believe in genetic testing. I want to see the big picture with my eyes wide open and do whatever I can to monitor and control the situation. If I have to choose a fear of the unknown or a fear of knowing the truth, I prefer the latter over the former. The glass is still half full even if there is a dash of BRCA2 in it.
If you still are not sure, speak to your doctors and seek out others who have undergone genetic testing. You have my opinion. I got it off my chest!
So, I really am my father’s daughter: a chip off the old genetic block. He died before knowing that I had the gene, our special bond. I am glad he never knew; it would have made him sad although it also would have brought us even closer. We shared the same spirit and the same courage to face anything that comes our way with a certain inner strength and sense of humor.
If I were a parent I would want my daughter or son to know and understand the realities of genetic testing and help them make their own choices. I told a few relatives who I felt should know about the gene just in case they wanted to get tested themselves. I don’t think they did. Some people just do not want to know.
If my father were alive today he would tell me, “I am proud of you Melanie. You did the right thing. We will face it together.”
In many ways we did.
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