My Mother, My Daughters, and Breast Cancer Awareness Month

Genes cause cancer. But genes do not necessarily cause death from cancer.

Breast Cancer Awareness Month is a time of both hope and remembrance for me. Hope for a better future, and remembrance for my Mother. She died suddenly of metastatic breast cancer at about the time I was going to deliver my second baby daughter. It didn’t have to be that way. Losing my Mom to breast cancer haunted me for a long time, and as my writer and reader friends know, I write about that and other real-life horrors.

We make up horrors to help us cope with the real ones.

Stephen King

Breast Cancer and Survival

When my Mom found out she had breast cancer, I was already trained as a geneticist. But at that time we didn’t have predictive tools like gene testing. Now, access to a simple test for BRCA DNA and many other genes can make a world of difference for a person’s prevention or survival from cancer. For some people, genetic testing shows the best ways to prevent cancer in her future, or to treat her cancer earlier, or to use prescribed drugs that are most likely to work best for her – all things that can lead to a longer life.

3D DNA image.

But it isn’t really all in the genes, because the medical care a person with cancer gets, or doesn’t get, and the place she lives, and the socioeconomic or racial biases of her clinical caretakers – all can change her chances of survival. A cancer patient’s survival is sometimes shorter in rural areas than urban, for community sites than cancer center sites, for places of poverty than wealthy areas, but especially for women who are Black and African American, than for others.  For my Mom, who was a white woman, lived in a rural area, was treated at a local community site in a poverty-stricken area of the Catskills in NY, chances were not the best.

Rural graveyard in my childhood home of Freehold, is in a remote area where healthcare services for breast cancer treatment are not available easily.
Graveyard in my childhood town, Freehold

When people die early –  before reaching our 65th birthday, we most often die of cancer where I lived as a kid, in the Catskills, and where I live now, NYC. Many families lose loved ones too soon from cancer. My mother’s breast cancer had spread from there, where she had no signs or symptoms, to her liver and beyond by the time she was diagnosed. In her liver, it grew and swelled undetected, until doing her daily physical exercises got difficult. Then she went to get checked out – she was 57. She died a few short months later from metastatic breast cancer.

Of course it didn’t have to be that way. Healthcare providers sometimes refer women for a yearly mammogram that can find breast cancer early. Finding a small cancer early on is easier to treat – right there where it is, before it spreads to other vital organs, like the liver. Some clinicians refer women for even newer and better screening tests now, like 3D mammograms and sonograms and scans that can be better than mammograms at finding cancer early. 

And of course, now, more intense cancer prevention is available by looking at a person’s genes, and our family genes, with genetic testing

Why Doesn’t Everyone Get Genetic Testing for Breast Cancer?

To be lucky enough to get genetic testing, a person has to be referred by a healthcare provider, a clinician – and have the right kind of health insurance coverage, or have enough funds available to pay for gene tests. Maybe most importantly, she has to know that gene testing exists and can save lives.

Some of us don’t get genetic testing because we don’t at all want to know if we are at high risk for cancer or another disease. For me, I usually think life is short, I get the most happiness I can out of it, which means not thinking about getting cancer any more than I absolutely have to (like every time I think of either of my parents, who both died of cancer). But denial or fear is not ever the whole thing. 

Might I have cared about getting genetic testing if a healthcare provider or clinician brought it up with me at a medical visit, despite my unspoken personal fears and denials? If a doctor referred me for genetic testing, would I not have gone? I don’t know – but I almost always go when I am referred for something. Every clinician I have ever seen knows my mom died of breast cancer and my dad died of lung cancer, because I always bring it up at a medical visit. For 62 years, zilch, nada. No gene tests for me. I should have asked, of course, and I am working on the strength to do that one day.

The big question for me is: Will my daughters get genetic testing?

I don’t know. But that is where I have hope for the future. 

Maybe they will.

Belinda, a Shelter Rabbit Adoption

I adopted Belinda, a Dwarf Agouti female rabbit yesterday from the Manhattan ACC in Harlem.

Belinda at home 1/22/2022

Hoping to adopt, I browsed the Animal Care Centers of NYC, ACC website every day for a month to look at all the rabbits, and I “hearted” Belinda early on. When I finally clicked on the “adopt me” button around New Years, I was directed to AdoPets. The online application was extensive, including giving my landlord’s contact information and a personal reference, and then it took three weeks to be approved. By then I had a scheduled a timed appointment at the shelter two weeks out to visit the bunnies. I had a big hole in my heart left when my daughter and her two adopted bunnies moved out of our place and into their own apartment a few months back. Giving another shelter bunny a home with me seemed like the right next step for us.

The shelter modified their rules because of the COVID pandemic to ensure people were double-masked and socially distant. They were very careful. This meant standing outside in 20-degree weather until there was room enough in the shelter to enter without over-crowding. A young couple and small child were in front of us with a very quiet big dog. When my daughter and I finally were let inside, it was about a 45-minute wait along with 5 other people and three big dogs before we could go up to the bunny room. In the interim, we heard that the big dog who had been waiting outside ahead of us was a surrender, to be left at the shelter because of an intolerant landlord. That was heart breaking to the family and the other people waiting beside them. The Mom began crying and the dog looked miserable and very shy, waiting to be surrendered. I can’t imagine going through that and my heart went out to them.

All the cages in the rabbit-room were full, with no room for any new rabbits to take shelter. One of the rabbits was pending adoption and the others were adoptable and waiting for their new homes. Several rabbits were very large and black, a few were very large and white, and then there were some who were multicolored and smaller – about 12 in all. One was only a few months old and had a fluffy orange coat. Belinda was being shy in her small cage and when the shelter staff opened it, she didn’t want to come out. I talked to her through the bars, and then through the open door. When she inched closer, I pet her forehead very slowly which she enjoyed, leaning into it.

Rabbits would normally cover a lot of ground in one day, and jump, and run miles even, so I imagine it is difficult to stay in a small cage. Belinda was found on 138th Street in NYC along with another bunny two months ago, also a female, and people who saw them called the police. They brought them to the shelter. The other rabbit was now in a foster home, and that’s all the staff knew about Belinda’s past.

“The way rabbits live makes more sense to me than the way people live.”

– Marty Rubin

Adopets sent me an email as we were waiting, prompted by the shelter staff who was showing the rabbits. I was able to pay the fee and check out online in about 5 minutes. There was an added fee for Belinda not being neutered yet, and I had to promise that I would do that when they arranged an appointment, then the fee would be refunded. They are serious about neutering the rabbits, but their vet was way behind on procedures. A shelter volunteer took Belinda out of the cage gently, trimmed her nails and let her walk around in a pen of about 4 feet long and 3 feet wide for a few minutes. When the staff was about to move Belinda to our carrier, we were asked to stand outside of the room.

They brought Belinda out to us in the carrier, with a lot of hay, because it was so cold outside last night. The whole process really did take only about 30 minutes, which was the length of the appointments. When we left, no one was in the waiting room. We called car service carrying Belinda, and soon enough were at my home in Queens. My daughter stayed a few hours to watch Belinda explore her new surroundings before returning to her own apartment and her own two adopted bunnies.

Belinda’s exploration was very gradual. First, she would put her nose out of the carrier, but quickly retreat. Then she would put out part of her head, and again retreat. Eventually she stepped out but then turned and ran right back into the carrier. After about 20 minutes she walked around the room leaning forward very cautiously and curiously sniffing the rugs, cushions, tunnels, toys and hay. By later that night she was dancing – hopping and binkying – unmistakable signs of rabbit joy.

This morning Belinda is exploring the rooms of the house, hopping around and binkying, then looking for things to chew. She is very friendly and circles around me and comes up to me often to put her head down in a way that asks for forehead pets. She ate hay and Timothy hay pellets well, and she looks healthy. She seems happy, exploring away, and I can only hope that her new home is a place where she feels free.