I must, I must. . .

Yesterday, one of my patients tried to look down my shirt as I was examining him. As he was in his 80s and pretty harmless, I didn’t make a big deal out of it, vacillating in my head between being disgusted, flattered, and amused all at the same time. Obviously, I try to dress in a way that would not make it easy for any of my patients to do, but as a woman, it’s an occupational hazard having breasts, no matter what size they are apparently or what kind of work you do.

I think all women have complicated, convoluted relationships with their breasts. Now most men might agree that all relationships with women are complicated and convoluted, and in this particular case, I think I’d have to agree with them. This is a relationship which predates most marriages (and for some outlasts their marriages), so it is one with a long history. As our feelings for our partner may change over time, I think it is true for women and their breasts as well. From wanting so badly to get your first bra and doing exercises to help them get here faster, to being unable to wait until you even get upstairs before taking your bra off when you get home from work, the gamut of emotions associated with developing breasts, having them, possibly breast-feeding, and for some women, losing them, is wide-ranging.

In my family, it is even more complicated than most. With a family history of breast cancer, I started having to get mammograms earlier than most women (yep, just as not-fun as you would think). As a physician assistant, I have access to all the studies and breast cancer data I care to read about, and have seen a mastectomy and biopsy from the operating room perspective. Though I am a person who would prefer to have the data versus not having it, some images stick in your mind,  and though I am a better PA for having seen it, I don’t know that I am a better patient.

When my mother asked my sister and me if we would mind if she underwent genetic testing regarding BRCA1 and BRCA2, my immediate response was “Of course not!” (more data for this brain=yes). I know for others this discussion might have gone a lot differently. I had the same conversation with my oldest daughter, who at the time was the only one old enough to understand the ramifications of getting these results, and luckily she was in agreement. Because of the odd way my brain is wired, images of Amazonian warriors who removed one breast in order to be better fighters flitted through my mind the night before we received the results. I imagined what I would do.  Could I be one of those Amazonian warriors? We were relieved to find out that my mother does not carry the BRCA1 or BRCA 2 genes.

Like in one of those late night commercials (But wait, there’s more!), what I hadn’t anticipated when we all sat down with the results was that the genetic counselor had calculated my risk of being diagnosed with breast cancer. Now, I know, that in medicine, there are no absolutes, and everything is based on percentages and previous studies, etc., etc., but when someone gives you a number in black and white, it rattles your cage a bit.

About 1 in 8 (12%) women in the US will develop invasive breast cancer during their lifetime, according to the American Cancer Society’s website. When I first heard that number, it seemed ridiculously high. The number the genetic counselor gave me was about 3x that number. Though I am usually pretty good with numbers (I still remember my first college apartment phone number), my brain somehow refuses to let me remember this number. I have to look it up every time, as if my brain looks at it and just says, “Nope, won’t accept that.” I know that she went through a whole explanation of how she arrived at that number given our family history, but in that moment, I was not a physician assistant. I was just like any other woman, hearing something that I did not want to hear, and her voice started sounding like the teacher from Charlie Brown’s voice.

So, it’s complicated, like the Facebook status. I love being a woman. I love everything that having breasts has given me. From a purely biological and anatomical perspective, they have been pretty darn useful, having allowed me to nurse 3 babies (though don’t ever let anyone tell you that breastfeeding is easy for everyone). Would I cut them off to save my life so I can live to be 100 and torment my great-great grandchildren? Absolutely. Do I want to have to be faced with that choice? Definitely not. There are harder things in life, and many, many people have been faced with much worse choices, but this is what the reality of modern technology has made possible for all of us. This ambiguity of risk calculators is almost worse.  We can know and agonize ahead of time about what may come to pass, or we can do what everyone before us has done without that knowledge, and just carry on. Sufficient unto the day, as the Bible says. Data, or no data, I am just trying to live my life one day at a time, and enjoy the fact that even at 80, someone is still trying to look down my shirt.

Today I am thankful to be a woman, grateful for all the good work genetic counselors do, and am especially thankful for all the breast cancer survivors, especially those warriors in my life fighting the good fight with grace and dignity.

Here is the link for breast cancer statistics. Please check with your primary care provider (and if she’s a PA, give her a hug!) to see when you should be getting your mammograms, and do your monthly self-breast exams! I know there are contradictory statistics regarding both, but I’ve also known women who saved their own lives by doing this, so get educated so you can make an informed decision, please!
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics

And another picture, just to make you laugh (I have no ties to whomever designed this, just think it is pretty funny and hope you will too):

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