A Tribute to Aunt Patti

On Saturday, I learned that one of my father's cousins, a woman I knew as Aunt Patti, had passed away. The cause: breast cancer. She was only 54.

I hadn't seen Aunt Patti in 15 years, maybe more. When she remarried, she moved to the west coast of Florida. I received a wedding gift from her last fall, but I had no idea she was sick. From what my mother said, Patti didn't tell many people; in fact, she was gardening in her yard just last week. Apparently she became ill about five years ago and had a double mastectomy, but the cancer came back recently and claimed her suddenly.

When I spoke to my father on the phone after the funeral, my first thought was "The gene claims another victim." But he reminded me that Aunt Patti isn't on the affected branches of the family tree: her mother was my grandmother's sister. But my grandmother had breast cancer twice, so it's possible there is a hereditary strain of cancer on her tree, too. (If there is, it wasn't passed along to my father, and therefore wasn't passed along to me. My father was tested for possible mutations from both of his parents -- wouldn't that have been a shitty hand? -- but came up positive only for the variation from his father.) But then again, since my BRCA diagnosis, I have a tendency to see family histories where they may indeed be none; it's a bit like buying a Volkswagen Beetle and then suddenly noticing them everywhere on the road.

Patti's death affected me more than I thought it would. It's the first breast cancer death since I've learned of my genetic predisposition to the disease. And it's also a stark reminder that breast cancer kills. Since one of the options for living life with the BRCA mutation is to screen regularly and aggressively so that any malignancies are caught early, there is a tacit implication that breast cancer is not that big of a deal. I mean, think about it: Screen until you get cancer, then treat it. But what happens when you can't treat it? My Aunt Patti got a double mastectomy and still the cancer returned (my father said it was flecked throughout her whole body). According to the Centers for Disease Control and Prevention, about 184,500 women were diagnosed with breast cancer in 2005 (the latest year for which statistics were available); more than 41,000 women died from it. That's about one in five. And that scares the crap out of me.

Unlike ovarian cancer (the other side of the BRCA coin, which is difficult to detect and to cure), breast cancer is so often viewed as both easy to diagnose and simple to treat. And with regular screenings, it can be caught in its early stages in most BRCA carriers. But once you have cancer, you can never go back; you might be in remission, you might be "cured," but you are never totally in the clear. BRCA mutation carriers have an elevated risk of developing second cancers (which are different from recurrences); according to the FORCE website, "one study found that BRCA carriers diagnosed with breast cancer have a 14% chance within ten years of developing the disease in the same breast, and a 37% chance within ten years of developing the disease in the opposite breast. Another study found a 40% chance for BRCA carriers to develop cancer in the opposite breast within ten years of their initial diagnosis. The risk for a second breast cancer among women who develop sporadic cancer is about 10%." So if were to get cancer -- which, statistically speaking, I will -- I would always be waiting for the other proverbial shoe to drop. And you think I'm stressed now? You ain't seen nothin' yet.

Patti's death comes at a difficult time in my BRCA adventure. Recently, I've been second guessing myself, debating whether or not a prophylactic mastectomy at this point in my life is really the right course of action. After all, I just got a clean bill of health, right? I mean, my breasts are healthy; why amputate them? But then I hear about someone like my Aunt Patti who didn't have the information I have, who didn't have the chance to beat cancer before it beat her, who tried to do all she could to fight but still lost in the end. And I know I have to do this. I'll probably never be one hundred percent sure I'm making the right choice (after all, I don't have a hundred percent chance of getting cancer; what if I'm part of that lucky 10% of BRCA carriers who never fall ill? Well, once my breasts are gone, I'll never know), but losing women like Patti makes me realize how lucky I am to have the option to drastically lower my risk of developing a disease that kills. I know Patti would have wanted to live -- for herself, for her husband, for her daughter. So I will exercise an option she didn't have and keep her spirit alive in my heart and thoughts.

Rest in peace, Aunt Patti.