October 18, 2007
Counting my bruchas
Yes, "brucha," the Hebrew for blessing. Initially, I was being facetious by giving a Jewish pronunciation to the "Jewish gene"; at age 56 I had been diagnosed with breast cancer, and "tumor humor" helped me cope.
Fortunately, I was diagnosed with non-invasive breast cancer, for which I underwent a lumpectomy and radiation. Because my cancer was "caught" at Stage 0, I was spared the trauma of a mastectomy or chemotherapy.
My yearly mammogram detected the tumor. I was shocked by the findings. My mother and grandmothers never had the disease. I had never had a suspicious mammogram, was thin, exercised, didn't smoke or drink.
So what did I do that allowed my body to betray me? Had I been exposed to carcinogens at work or at home, ingested chemicals that caused my cells to mutate, compromised my immune system by overreacting to stress? I never considered that Jewish genetics might have been the culprit.
My oncologist analyzed my family's cancer profile. My uncle was diagnosed with prostate cancer in his 80s; his daughter with breast cancer in her late 40s. One grandfather died of pancreatic cancer at 85. That same grandfather had a niece diagnosed with ovarian cancer at 56, another with breast cancer in her 40s and a third with colon cancer. And my grandmother's brother died of breast cancer. Although rare, breast cancer in men is especially lethal and a significant indicator of a BRCA mutation.
My oncologist recommended genetic testing to assess my risk of recurrence. Although the probability of having the BRCA defects is low (only 1 in 40 to 50 Ashkenazi women), their existence dramatically increases the lifetime risk for developing breast and ovarian cancer (estimates range from 36 percent to 85 percent for breast; 20 percent to 60 percent for ovarian). If I tested positive, I could opt for prophylactic surgery, i.e., removal of my ovaries and/or bilateral mastectomy.
I had been hearing of increasing numbers of Jewish women with the BRCA mutations electing to go this route even without a cancer diagnosis. Losing my breasts and ovaries! I cursed those "brucha" genes for leaving me with such options.
I was relieved to learn that I did not have the "bruchas" after all. Yet, oddly enough, I began to suspect that just having breast cancer might have been a "brucha" in disguise.
With any life-threatening illness, survivors often say that their priorities change with a focus on what really matters in life. That shift also happened for me. Things that previously upset me, like waiting in line, dealing with incompetence, bearing the brunt of someone's misplaced anger or encountering people "with attitude," I now take calmly in stride, knowing that whatever might bother me "just doesn't matter." I remember what counts -- my health, my family and friends, my writing -- and the source of my upset diminishes in power.
This more positive mind-set also helped me face the death of my mother and the outsourcing of my job after 20 years of dedicated service. Both losses occurred within nine months of my diagnosis. While I mourned my mother's passing and ranted over the unfairness of losing my livelihood, I was also able to appreciate the "blessed aspects" of these traumas. My mom died in her sleep, suddenly and peacefully.
"If you get a call that I died in my sleep, be happy for me," she always said. And being forced to leave my job released me from the "golden handcuffs" of a pressured daily grind.
Breast cancer also woke me up to the reality that I am not "the supreme commander" of all the circumstances in my life. Getting cancer is a crapshoot. I spent a wasteful amount of time ruminating over what I did to cause my cells to mutate.
So, while I would in no way recommend a malignancy to transform your life -- hearing "You have cancer" is no fun, and being irradiated for five weeks is no joy ride -- for me, given that breast cancer was my lot, the experience was ultimately transformative.
Now, back to those "brucha" genes, BRCA1 and BRCA2. I even have a kindlier way of looking at them. Thanks to their discovery and the use of genetic testing, women of Ashkenazi Jewish ancestry carrying the mutations can reduce their high risk -- aggressively through surgery or non-invasively using MRIs, sonograms and frequent mammograms. They can fight the odds of developing breast and ovarian cancer, thereby saving their own lives and the lives of other family members. Honoring the sanctity of life -- is there a greater "brucha" than that?
Fredricka R. Maister is a journalist and screenwriter who lives in New York City. Her articles have appeared in several publications, including the Baltimore Sun, Miami Herald, Philadelphia Inquirer, the Forward and in the archives of the United States Holocaust Memorial Museum.