Day 1,057: Angelina Jolie and Me

I can't count the number of people who have asked me "what do you think about Angelina Jolie?" Those people are not asking me what I think of her acting skills or her tattoos or her large brood of international children. They are asking me what I think about her discussing her decision to have a double mastectomy because she is BRCA+. My first thought is this: What does that have to do with me? She's BRCA+. I am not. I had breast cancer. She did not. It's strange how people think that if a celebrity deals with something cancer-related, you must just UNDERSTAND each other. On the other hand, moments like these are valuable because they open up a conversation that is much wider than any I or any of the normal run of the mill average Jane cancer survivors could elicit. So here's my two cents on what I think about Angelina Jolie, and then here's my 50 cents about what I think about a lot of other things:

Good for her. Angelina Jolie could be awesome or annoying--I have no idea, and neither do you. But one thing is true: She knows how to use her celebrity to get the word out about things. Her situation is one in which loved ones died from cancer, and she found out she was susceptible as well. She made a decision that she sounds very happy with, and her family is happy with it, and she told people about it in an editorial that is quite well-written. She speaks some useful truths: acknowledging that her risk of breast cancer does not go down to zero due to the procedure, highlighting that only a small fraction of women with breast cancer carry the BRCA mutation, discussing the high cost of genetic testing and giving a shout out to lower-income women who don't have access to it, putting in writing the shocking number of 458,000 people who die from breast cancer each year, saying that most women with BRCA have a 65% chance of developing breast cancer (Jolie has been criticized for saying that she reduced her risk of cancer from 87% to 5%--because 87% is too high a number for BRCA+ women. However, if you actually read the editorial, you will note that she gives the correct percentage for BRCA and then says that her doctors gave the 87% number TO HER SPECIFICALLY). She has been criticized for talking about the minimal scarring, the beautiful results and the quick recovery time. But if she had minimal scarring, beautiful results and a quick recovery time, who are we to judge?

Good for her.

It is not Angelina Jolie's fault that the media, women, breast cancer advocates and everyone else under the sun will use her situation to spread false information about cancer, about breasts, about mastectomies. She told her truth and is using her fame to help other people who might find themselves in her situation. If Angelina Jolie undergoes an ooverectomy and volunteers herself for surgically-induced menopause, and then goes out there talking about how difficult it is to deal with the changes of menopause for young (and all) women, she will reach that Goddess-like state of awesomeness for me. And if she doesn't do the surgery or doesn't talk about it if she does, it is none of my damn business. I am also left to wonder why there were so many articles that asked Lance Armstrong about his testicular cancer, without any of them even mentioning his testicles or lack thereof in the case of the one.

So that's my two cents. Here's my 50 cents.

If you put 1,000 women in a room, 120 of them, give or take, will develop breast cancer in their lifetime. Six of the 120 will be BRCA positive. Those 6 women are important. The discovery of the BRCA mutation is one of the most exciting cancer-fighting developments that exists, because it offers a chance for prevention for some women, but also for this reason: Knowing you are BRCA+ IF YOU HAVE BEEN DIAGNOSED WITH BREAST CANCER ALREADY helps doctors manage your treatment plan. It is also important because it is one small window into the role of genetics and DNA sequencing in cancer. It explains only a tiny fraction of breast cancers, but that is better than nothing.

Many of us have nothing. I am one of the 114. More specifically, I am one of the 18 women in the room with triple negative breast cancer, an elusive and mysterious beast.

We have nothing to go on--we know about a slew of risk factors, many of which didn't present in our lives, many of which do not even apply to our non-estrogen-receptive type of breast cancer. If you are a thin 34-year old non-drinker who exercises like crazy and is busy nursing a baby all day, you don't think you will have breast cancer. And, yet--maybe, you find out that you do.

So, given that she knows that she is speaking about a specific situation that a minority of women might find themselves in, I appreciate Jolie's sentiments for what she does NOT say. She does not say that mastectomy was the right choice or the only one. She says it was the right choice for her. I know other women in the same situation who have made different choices. They were not WRONG.

This relates to one of my personal pet peeves about how we talk about breast cancer. There are so many in our society--including cancer survivors--who talk about certain surgeries or treatment options after a cancer diagnosis as if they are the only right decision. People say things like "I had cancer in one breast but I had a double mastectomy because I'm smart, because I'm educated, because I wanted to do all that I could." The implications there are that those who had single mastectomies or lumpectomies are dumb, uninformed, even lazy. The reality is that breast cancer is complicated. I was told, after a lot of teeth pulling on my part to get the docs to be straight with me, that mastectomy--single or double--would not increase my chance of survival or disease-free life AT ALL. Lumpectomy and radiation would offer the same benefits. I chose to do the latter for a variety of reasons, which I've outlined here before, and I think it is totally reasonable and understandable that other women make other choices. For me, I heard what was under the doctors' admissions of the lack of difference in my chances. My cancer subtype, triple negative, was MUCH more likely to metastasize to a distant area of the body than to recur in the breast. And cancer confined to the breast never killed a single person--not one. If my cancer recurred locally, but didn't spread, I would survive. Mastectomy would not lower the risk of cancer cells that had spread throughout the body. Only chemotherapy could do that, and there was no guarantee that that would work either. In 2010, they offered completely different chemotherapy for TNBC than they do today--but of course, I couldn't know that in 2010.

I have absolutely no idea if I made the "right" decisions, and neither do my doctors, and neither do you. No woman with breast cancer knows that. This disease can rear its ugly head when you least expect it, and that is a truth that millions of us have to live with every day, without knowing if the methods we used worked. We are doing the best we can with the information available to us at the time. As I said to more than one doctor who asked me what I wanted to do, for each one of the literally hundreds of decisions I had to make about my care and treatment plan: "I want to go home."

And that was the one choice that I just didn't have. So let me be the one to say that there is too much emphasis on our POWER over this thing--too much emphasis on what we can control, what is right, what is "heroic."

Let me say this: You are not more heroic or more informed or smarter if you are diagnosed with cancer and get a mastectomy, if you have to do chemotherapy, if you have a positive attitude, if you survive, or anything else. My husband said it this morning: "It's heroic to deal with breast cancer--period." This is not a competition, nor a game.

There are 120 scenarios present in the 120 women who find out they have breast cancer. Some might choose mastectomy in part to avoid radiation or chemo and then find out that they have to do it anyway because cancer has spread to the nodes. Some women undergo every aggressive treatment and surgery under the sun and their cancer metastasizes despite their best efforts. Some women do a lumpectomy and radiation only and live long lives without a recurrence. The problem right now is that we don't know who is who. BRCA provides a glimpse, and that is a great stride that has been made in cancer research. But currently, only 1-2% of breast cancer research dollars go toward understanding metastatic disease--which is the only type of breast cancer that has ever killed anyone. That is shameful.

My personal favorite breast cancer celebrity is Robin Roberts. I admire her not just because she is the first famous person I know of to talk at length about TNBC or because she looks so amazing bald. I admire her for her honesty in talking about the difficult things. She has said things like "There is no remission for my cancer," "I'm not out of the woods," "you have days that are so hard you don't think you can go on," and she has shown, to millions of people, the terrible potential effects of toxic chemotherapy as she fights a potentially fatal blood disease brought on by her treatment for breast cancer. Many women will never go through what she has gone through, but she has given a public face to those who already have.

If I were famous, I would talk about triple negative breast cancer, and the relatively high chance of metastasis. I would talk about being a nursing mother at diagnosis. I would talk about sexuality and menopause and my hatred of pink and of slogans like "groping wives means saving lives" and the seemingly ubiquitous feeling that we are, that I am, just breasts and hair and nothing more. I would talk about what is true for me. I am not famous, but that is what I have been doing in this forum for the last three years. I don't claim to represent anyone else. I have talked about this body, this disease, this experience, this woman.

The thing we should all remember about something like cancer is that behind every positive story of empowerment, behind every happy ending, there is so much suffering, fear and death. It is the least we can do for those who experience that reality. And there are many, many people who understand this--including some who are famous, and some who are not.

The other day at my gym, people were discussing the community walk that raises money for breast cancer treatment at a local hospital. A few women were talking about how big this walk has become--more than 12,000 people participated this year, and it started out as just a handful of women walking down the street. One woman remarked that this was inspiring, and amazing. The other woman, older than the rest of us, with a wizened look on her face that told me she probably knows a lot of things that the rest of us don't know, said this:

"Well there are so many because, Jesus. There are so many."

Day 833: I Hate Breast Cancer

This picture was taken about a week after my cancer diagnosis in early May, 2010.



October is supposed to be a month wherein I feel celebrated, but in so many ways I don't feel anything but lost. And angry. And I've been supposedly "done" with cancer for almost two years, so I shouldn't feel that way, right? When I bring up any kind of fear to those I'm closest to, they of course tell me that I beat it, that I haven't had cancer in my body since June 4, 2010, when my tumors were removed, that I will live a long life. They tell me that because they have to believe that because of the pain it causes them to think otherwise. So, mostly, I keep it to myself.

Except here. This is my place. The place I go when there's nowhere else to go in this Cancerland. So, I'm going to list a few of the reasons that I hate cancer and am angry at cancer and I don't care who reads it or how un-inspirational folks think it is.

I hate breast cancer because:

It isn't like other cancers. You can catch it "early," and it can still come back and kill you--months, years, later. Some new conventional wisdom estimates that a minority, maybe only 30%, of breast cancers are helped through early detection. Early detection does, however, help in one major way:

It helps us as a society think of breast cancer as a benign disease that is easily "beaten," and infinitely survivable. "Survival" statistics for breast cancer mean one thing and one thing only: how likely is it that a woman who is diagnosed with breast cancer today will be alive in 5 years? 5 YEARS people. That wouldn't even get me to 40. And the reality is that early detection might mean that I will have known about my cancer longer than someone else who found the same cancer later--so technically I have a better chance of "surviving" 5 years, even if that other person and I live the exact same amount of time with our cancer. If you have breast cancer for 8 years, at which point you die, but find out about it 2 years into the tumor's growth, you will be one of the 5 year survivors, pumping up breast cancer charities' statistics. If you discover the tumor 5 years in but still die after it's been there 8 years, you will not be a 5 year survivor, and charities will be able to use you as a test case to show why early detection is so important--even though it didn't do jack shit for that other lady's life expectancy.

But I digress. I also hate breast cancer because:

I didn't even have breast cancer. After I wrote the blog about new breast cancer research showing that TNBC more closely resembles ovarian cancer than breast cancer, I really lost it. I waited for Gabe to take the kids out, and I just sat down and cried. I cried in the truest way that Katy Jacob can cry--for a few minutes, maybe two and a half, and then, I just stopped, because that's what I do. I'm not sure if I know how to cry for long periods of time anymore. I sat there and thought about the women I know who are diagnosed as TNBC today, who take taxol but not AC chemo, and are offered totally different, less toxic chemo regimens that have been used for ovarian cancer for years. I thought about PARP inhibitors. And now, I think about how much I suffered on AC, not just in the normal ways that people suffer on those poisons, but in all the other ways that were specific to me that gave my doctors pause. It might be hard for you to hear this, but imagine--just imagine--how hard it is for me to say it: I DID THAT FOR NOTHING.

I hate that I risked permanent heart damage, that could happen at any time, I risked the potential for other lethal forms of cancer caused by the drugs, I got so weak and sick and scared my children and had morbid insomnia and lost the ability to sweat for an entire year and I could go on, but the important thing is that IT WAS FOR NOTHING. I told my mom I wished I had been diagnosed TNBC 8 years ago, so it wouldn't seem so cruel to learn what I've learned just two short years later--two years too late. I would have lost my hair and gone into menopause on taxol anyway, but, man...that Red Devil, that Red Death--adriamicin. That Cytoxan that could almost kill you just looking at it. For nothing.

I hate breast cancer for reducing women to their tits. Even other women do this to us. If you do one thing for me, do this. Do not save the tatas. The tatas don't matter. Sure, I'm glad I still have mine. But if I find out in a few years that my cancer is back, what good will that do? Save me, save my life, not my tits.

I hate the misinformation. It's pretty clear that for women who are triple negative but also BRCA-, the risk of local recurrence is low. It's high for BRCA+. But for me? Cancer is much more likely to return in my liver than in my other breast. So why are doctors still encouraging double mastectomies in some cases like mine? Why do women think that mastectomies will save them when that is only true in certain circumstances? Why do people who mean well, friends of mine even, say things about breast cancer like, "oh I heard it wasn't really that bad" when 100 women die from the disease in this country every day? When 1 of your seven best friends, or you, will have it--WHY?

I hate the pink. I hate people making money off of my suffering and my family's potential loss without any real benefit for breast cancer research or any substantive changes in survival rates over the last several decades. The death rate of breast cancer is stubborn. It might look like it's falling, if you compare how many women with breast cancer die from the disease today compared to 20 years ago. But that is the wrong statistic, and it goes back to the early detection thing. Mammograms just found more cancers, so breast cancer rates increased, because women now knew they had something they didn't know they had, and the death rate became a part of that larger number. But the real number, the one that looks at breast cancer deaths per capita for women as a whole, not just women who have been diagnosed? THAT SHIT IS THE SAME. YOU ARE AS LIKELY TO DIE FROM BREAST CANCER TODAY AS YOU WERE 20 or 30 YEARS AGO.

I hate, more than anything, the fear. I hate how I have felt the last week in the gym or when walking up the hill to my house. My ankle has been giving out, hurting, refusing to correctly support my weight. I ignored it, but then I started to worry. Bone mets below the knee is rare, with about a 1-3% occurrence rate of all bone mets from breast cancer. That should make me feel better, right? Well, maybe, if I hadn't been in the 2% for all the other shit that's happened with this damn disease. Oh, I just twisted my ankle, I did it during spinning or when running after my kids or it's just because I'm getting older, right? Well, yeah--if I was normal. If I hadn't had cancer. If I didn't know young healthy women who thought they had beaten the beast only to find out they had bone mets when they were running a race, who didn't find out until they had reached the 5 year mark and thought they were free, who were thin and active and awesome and beautiful and strong and cancer just didn't give a shit. I hate having my first UTI in years, ironically just after we were finally able to give up the condoms (!!) when Gabe got the all-clear after his vasectomy, and wondering, somewhere, if that's really what was going on. All that peeing could have been a symptom of bone mets or something else, after all. I hate how scared I was of possibly getting pregnant, how I felt like a teenager, how I told Gabe, but we are not like other people, we cannot have an "oops." We have to be sure.

I hate talking to my husband about death in our marriage bed.

Some days, but not many, I hate my hair. Most of the time I love it, but I have my days when I think about that long curly hair and I want it back. And even in the middle of those moments I know that I have no patience to grow it out, and that even if I did, I wouldn't want it once it was there, because I wouldn't recognize that woman anymore.

I hate that she's gone.

I hate that I do the right things, in the normal ways, and how normal it makes me seem. I call in and ask for a strong dose of Cipro, and it works, and there goes the UTI. I modify for the ankle, it starts to feel better, and I realize that wouldn't happen with cancer. I have never been truly depressed from cancer, never been medicated, never had anxiety attacks, never been unable to work or take care of my kids or laugh or live my life. And so it is as if it was all in a dream, including the suffering I endured needlessly and the thought of the medicines I could have taken that might have helped that weren't offered to me. People forget about it, or are sick of hearing about it, and assume I am a hypochondriac or a drama queen when I've never been anything but a realist about this nonsense. I am supposed to act like I "won," but it's hard to believe that when none of us had even correctly identified the guy on the other side of the ring.

I hate breast cancer.

This month, wear green for me. It is, after all, the color of the earth during its healthiest time, and yet it is also the color of envy, the color of youthful ignorance. The one I'd love to go back to someday.



If you're looking for more lighthearted posts, I can also be found at livechickenonsix.