Breast cancer risk has defined my life in key ways, starting with my mom’s death from the disease when I was seven years old. While I was in high school years, my stepmother took the then-unusual step of having a preventive double mastectomy because of numerous breast cancer cases over multiple generations in her family. In my 20s, breast cancer became a conscious part of my personal health profile, discussed at every doctor appointment. Then, in my 30s, with three young children and approaching my mom’s age of diagnosis, breast cancer risk loomed as my inevitable fate, especially after my mom’s youngest sister, then age 55, was diagnosed with it.
It became imperative to confront this medical risk. At the time, I was still breastfeeding my youngest son, which presented an obstacle to the logical step of having a screening mammogram. When he transitioned to nursing only at waking and bedtime, my midwife suggested I go ahead and schedule the scan. She thought it would be fine. However, at the testing center, after I answered honestly to all questions on the registration form, including the one about breastfeeding, a technician was summoned from the back. She glanced briefly at the paper and then leveled judgement: “Valid scans cannot be obtained on lactating women! We will not see you today.”
I was torn, unsure what to do next. Breastfeeding was integral to my mothering. My son and I both relied on its nourishing, calming effects. Was the risk of future cancer worth upending our bond? That didn’t feel quite right, but fear of dying young hovered relentlessly. I never knew when it would engulf me like a tornado, threatening removal from the life I loved. Gripped in its vise as I woke to a new day or tucked in my precious ones at night, my heart pounded in dread. One day I revealed my worries to a mom at my children’s preschool. She was a nurse, and her reply changed my life.
“I know someone else with this kind of family history. She sees a breast specialist once a year, in addition to her regular physical. You could do that and start mammograms when you’re ready,” she said, and recommended a doctor named Karen Columbus. “Thank you!” I said. A plan lent a degree of control, and if one day I found a lump, at least I’d already have a doctor.
Into the Labyrinth
Despite this sound rationale, at my first appointment with Dr. Columbus, I trembled in the waiting room, having traversed the labyrinthine halls of the hospital complex to the office suite as though walking the plank to a death sentence. Posters on the wall advertised wigs, while pamphlets in a rack illustrated how to perform a breast self-exam. Suddenly it all felt too real, and my chest tightened. What was I doing here? I couldn’t possibly have breast cancer. Yet, my mom had confronted the disease at this very age.
An image of my dad flashed through my mind, seated on my twin bed in the room I’d shared with my sister, our two brothers standing behind him. I heard again how Dad’s voice cracked when he said, “Well kids, we have an angel in the family.”
The memory dissolved as I heard my name called to see the doctor. In the exam room, after I explained my situation, the nurse, Nancy, looked straight at me with sorrow in her gray eyes as she said, “Oh, I am sorry. You were so young.”
She spoke as though my mom had died weeks ago rather than decades.“Th-thank . . you,” I stuttered, flustered but also touched by her kindness, unexpected in a clinical setting. When reciting my family medical history, I’d grown used to the listener’s eyes widening at my mom’s early death and its cause. Next would come a thorough questioning about other family members while making careful notations in my file, and I’d feel like an exotic lab specimen. This time was different.
When Dr. Columbus entered, I found her surprising. Slender and fit, she was about my age and looked like she’d just come from the beach, with tan skin, dark eyes, and blond highlights. I sensed our mutual assessment of one another as we talked. To my great relief, she did not order me to stop breastfeeding and have a mammogram. Her blank expression suggested withheld doubt about the need to continue nursing past infancy, but such restraint invited my trust. She only urged a mammogram in general terms. Unlike all the other health professionals I’d ever told my story to, Dr. Columbus seemed unimpressed by my mom’s pre-menopausal cancer.
“All women are at risk for breast cancer,” she said with a small shrug. “Your aunt was at menopausal age when she was diagnosed. That’s very different than your mother, who was young. You may have more risk, but we all need to be vigilant.”
From her vantage point, it seemed, I was one woman among many with risk potential, not a uniquely doomed individual. Rather than sweeping me up in fear, her understated manner made me feel grounded. Continuing in a matter of fact tone, she handed me a brochure on the genetic testing program at a local hospital. “I strongly suggest that you pursue this,” she said, her chocolate brown eyes fixed on mine.
Though she’d given me a pass on the mammogram for the time being, I understood that she expected a report back the following year. The concept of genetic breast cancer was familiar to me because of my stepmother’s family, where the gene had been identified.
“Yep,” Dr. Columbus said, nodding, when I recounted that situation. “If you have the gene, I wouldn’t hesitate to say ‘lop them off’.”
The trifold paper sat on our living room table for a few weeks before I worked up my nerve to schedule an appointment. The process felt like standing at the entrance of a dark cave, until finally I walked another plank of hallways to the genetics consultation, only to learn that the test did not produce clear-cut results like cholesterol. Identifying a mutation is like looking for a needle in a haystack, the counselor said. Further, to my surprise, she advised that my aunt was the person to be tested, because her cancer history would focus the search. But, after being tested, it turned out that my aunt did not have the gene, so presumably my mom had not, and neither did I.
This outcome indicated almost nothing new. While it avoided a major surgical intervention, the ambiguity hardly reassured me about my breast cancer risk. However, it did affirm my plan for annual assessments with Dr. Columbus. By the next year, my son weaned, I had a mammogram, and it was totally normal.
“You have great breasts,” Dr. Columbus said, characteristically frank as she prodded and pressed my flesh during the subsequent appointment.
“Why, thank you!” I replied, grinning.
Laughing, she said, “I meant the tissue is clear, and they scan well.”
A year later, the practice moved to a suburban office building nearer my home, where they partnered with an imaging practice so that patients could have their mammogram and see the doctor all on the same day in a single appointment. It was almost too immediate for me. I hated the wait while the radiologist read my scan. On a memorable visit during my mid-40s, the radiologist found “a small mass.” Shaking like a leaf, I had to meet with him about it and then have an ultrasound scan before passing through the private hallway to Dr. Columbus’ office. “She will discuss options with you,” he said.
I sat frozen in the exam room, my gut clenched. Then the door flung open, and without preamble Dr. Columbus proclaimed loudly, “You’re FINE!”
Tears filled my eyes. “Really? But the radiologist said . . “
For just an instant, she pressed her lips together and shook her head ever so slightly in apparent annoyance with her colleague. Then her face cleared as she declared, “It looks like a lymph node. It talks like a lymph node, walks like a lymph node, smells like a lymph node. It’s a lymph node!”
“You’re sure. Oh my god, I felt terrified.”
With a wry smile, she said, “We’ll make him happy and re-scan in six months, but I’m not worried.”
Then she gestured me to untie the gown for the manual exam, and our conversation moved away from breast cancer risk to the usual chat about kids and husbands.
From then on, it became tradition for her to stand in the doorway and announce, “You’re FINE,” to begin our visit. I’d release the breath I didn’t realize I was holding, and sometimes even blink back tears. Her intuitive grasp of the fear that we’d never openly discussed always touched me.
Now twenty years have passed since our first encounter. Like an athlete with a strict pre-game routine, anxiety remains essential to my ritual. I alert my husband of its approach, so he’s just a text away at work, should there be scary news. I wonder, how many more clean scans can I have? Will my breast cancer risk catch up with me this year now that I’m 55 like my aunt was?
Nancy greeted me and again noted my young age at my mom’s death as she looked at my chart. Dr. Columbus said the usual, “You’re FINE!” But her expression appeared grave as she sat down and began to speak in the direct tone that I’ve treasured.
“I’ve begun letting my patients know that I’m going to retire next September 30. It’s still almost a year away, so I have a chance to tell everyone. We’ve already brought in a new doctor who is working closely with me so that it’s a smooth transition. She’s great! I think you’ll love her.”
“Oh . . ” I said, as my insides dropped. How would I cope without Dr. Columbus? “This is hard to hear. I will miss you. Thank you for telling me in person.”
I valued her like a friend, I realized, and surprised myself by continuing. “I am happy for you. You’ve worked hard all these years.”
“Yes,” she said, nodding. “I’ve loved practicing medicine. I feel very fortunate in my career. But it’s time for me to move on to a new stage in my life. I’m ready.”
In the car afterward, tears spilled as I sat with my head bowed and my hands braced on the steering wheel. So much gratitude welled up along with sadness as I recalled the terrified young mother I’d been. Reflexively I wanted to contact my husband for consolation, but then paused the reach for my phone, surprised by unexpected inner resolve. Visit by visit over the course of two decades, I discovered, Dr. Columbus had laid the groundwork for resilience. After a deep exhale, I wiped my cheeks and turned on the ignition. I would forge a new relationship to risk.