Hereditary Breast and Ovarian Cancer: What Slyvia, Pody, Gail and Elaine Had

I majored in English. This was mainly because “Sitting Around and Reading” was not an actual major and English was as close as I could get.

I am afraid that like an American abroad who seeks out McDonald’s, I never ventured much beyond the familiar comforts of home–I like American literature probably because there wasn’t a whole lot of it (comparatively speaking) and, for the most part the vernacular was right in my wheelhouse.

“All modern American literature comes from one book by Mark Twain called Huckleberry Finn,” said Ernest Hemingway. I liked Twain’s humor, especially in some of the minor details such as “Ode to Stephen Dowling Bots.” Most of the authors I truly enjoyed in college were best remembered for their short stories (Thurber’s Secret Life of Walter Mitty, O’Connor’s A Good Man is Hard to Find, etc.) As a student, I relied on Cliffs Notes, Monarch Notes and the lesser known but invaluable “Master Plots.” 

I graduated in 1987–the campus was just on the cusp of the desktop computing era and the first practical browser would not be released until 1993. Given the primitive resources at my disposal, I managed to sound like I knew what i was talking about. I used a lot of big words, pretentious phrases and a generous supply of Famous People quotes to spackle  over the  enormous craters of my general ignorance. At some point, I may have even believed I knew what I was talking about.

I came within one clove cigarette and a pair of black Mary Janes of pursuing a graduate degree in English. Even people with “real” degrees were struggling to find jobs in 1987. Staying in school was very tempting.

Paul saw a blinding light on the road to Damascus in 33 AD. Augustine heard a child chanting “Take and read” in a Milanese garden in September 386. My particular epiphany occurred during a sleepy afternoon session of Professor Howard Cole’s “Restoration Drama”  class in the spring of 1987.

In the midst of the usual riveting discourse on roistering, cuckolding and general  hey, nonny, nonnying, a fellow student asked a question that knocked me off my pins. This was an upper level class–we lowly undergraduates were treated like junior varsity players admitted to the sanctum sanctorum,  grudgingly allowed to sit on the team bench in case a starter got hurt or something.

A distaff graduate student with requisite black felt skirt raised her hand and described her dream from the previous night. “What might this portend, Professor Cole?” she asked. That killed me. I mean, who says “portend” in real life? What a bunch of phonies. I knew I had to get out of there.

Reading Amy Boesky’s memoir gave me the delightful opportunity to meet a different kind of grad student. Boesky teaches and researches in several fields, primarily seventeenth-century British literature and creative nonfiction. She also wrote quite a few “Sweet Valley High” books.

Boesky’s mother, Elaine,  died of hereditary breast cancer in the mid 1990s; at the time of her death  BRCA testing was just becoming a reality. Amy’s memoir, “What We Have” chronicles her family’s experience with hereditary breast and ovarian cancer. “We had black-and-white photographs of all the dead aunts and grandmothers and great-aunts [including Slyvia, Pody and Gail],” she writes. “… I used to walk up and down the hallway and look over this ill-fated, all-female family tree.”

Ovarian cancer is known as “the silent killer.”  If you have a family history, you will likely face the same issues as Boesky: the impetus to start your family sooner than later, the BRCA testing dilemma and potential prophylactic oophorectomy and/or mastectomy.

On a personal level, Boesky is hyper aware of time. (Come, let us go while we are in our prime ; And take the harmless folly of the time.) On a professional level, as the author of Double time: Women, Watches, and the Gift of Eternity, The Double Voice: Gendered Writing in Early Modern England, she is an expert on watches, calendars and all manner of time keeping.

Oophorectomy has been shown to be the most effective method for lowering risk for ovarian cancer in high-risk women. If performed before menopause, oophorectomy also lowers the risk for breast cancer in high-risk women.
Source: FacingOurRisk.org

Before returning to my discussion of “What We Have,” I have to say a few words about breast and ovarian cancer:

      • Most cancer  just happens–it’s sporadic vs. hereditary. The majority of people who develop breast cancer didn’t inherit an abnormal breast cancer gene and have no family history. But about five percent of people have a genetic mutation which predisposes  them to cancer.
      • Two abnormal genes BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) are associated with a higher lifetime risk of developing breast and/or ovarian cancer. (FYI, I do NOT have this mutation, my cancer is considered sporadic; I may well have some mutation for which there’s currently no test.)
      • From the NCI FAQ: A woman who inherits a harmful mutation in BRCA1 or BRCA2 has an increased risk of developing breast and/or ovarian cancer at an early age (before menopause) and often has multiple, close family members who have been diagnosed with these diseases. Harmful BRCA1 mutations may also increase a woman’s risk of developing cervicaluterine,pancreatic, and colon cancer (12). Harmful BRCA2 mutations may additionally increase the risk of pancreatic cancer, stomach cancergallbladder and bile duct cancer, and melanoma(3).
      • All of us have BRCA1 and BRCA2 genes according to  BreastCancer.org: ” The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.”
      • Ashkenazi (Eastern European) Jews are 10 times more likely to have mutations in BRCA1 and BRCA 2 genes than the general population. Approximately 2.65 percent of the Ashkenazi Jewish population has a mutation in these genes, while only 0.2 percent of the general population carries these mutations.
      • Note that most U.S. Jews are  Ashkenazi (their ancestors came from Eastern Europe) vs. Sephardic  (their ancestors came from Spain, Portugal, North Africa and the Middle East).
      • Having an abnormal BRCA1 or BRCA2 gene doesn’t mean you will be diagnosed with breast cancer: Only seven percent of breast cancers in Ashkenazi women are caused by alterations in BRCA1 and BRCA2 (See www.genome.gov/10000507.)

Back to the Review….

As Boesky explains,  her book  isn’t really a cancer story, or a survivor story, though it has cancer and surviving in it: “It’s a previvor’s story. A previvor is someone who doesn’t have cancer, but has a known (elevated) risk for it, discovered through family history or through diagnosis with a genetic mutation. That’s good news. If you’re a previvor, you don’t have anything—at least, not yet. The bad news is, that means you don’t have anything to fix or get better from. You can diagnose being a previvor, but you can’t treat it. There are things you can do, protocols to follow. But the previvor part doesn’t go away. It just becomes part of who you are.”

“What We Have” is not an advice book for people with cancer or their families. It is an extremely well-written memoir. Amy Boesky is a really smart woman but she isn’t a show off (unlike someone else I could name,  you know… ME…). On page 13 she reflects on her giddy first encounter with Jacques,  the man she would eventually marry. They were literally strangers on a train. She sat down next to him on an Amtrak trip  from Boston to Philly. He was half asleep–Boesky gave him a few “accidental” nudges to wake him up.

During their electric first conversation she learned Jacques was exactly a year and a day older. “Three hundred and sixty-six happens to be the number of love poems Petrarch wrote to Laura,” Boesky observes. “One for each day of the year, and then one more to represent perfection.”

Now, every three months or so when I have a CT scan with contrast, I have to drink something called Readi-Cat. Everytime I pick up the bottle of that stuff, I always think to myself, “The Readi-Cat is all.”  Of course I would never say this out loud to my sister (as Boesky did with her Petrarchan observations). Still, I am glad to know someone else thinks like this.

When her mother is diagnosed with bone mets, Boesky reports “I had a strange compulsion to tell everyone I met about her, like the speaker in “The Rime of the Ancient Mariner.” Well, my reaction to my diagnosis of the same was more turning and turning in the widening gyre, but yes, I have run into some Ancient Mariners of my own.

Boesky mentions that her mother, also a teacher, loved Dylan Thomas’ poem “Do Not Go Gentle.”

I give her bonus points for mentioning that this is a villanelle, which is not actually a really small village as I had first supposed. But I prefer “Fern Hill”:

And as I was green and carefree, famous among the barns
About the happy yard and singing as the farm was home,
     In the sun that is young once only,
          Time let me play and be
     Golden in the mercy of his means,
And green and golden I was huntsman and herdsman, the calves
Sang to my horn, the foxes on the hills barked clear and cold,
          And the sabbath rang slowly
     In the pebbles of the holy streams.

“Precise” is word several other reviewers have applied to Boesky’s prose and I concur. She’s got le mot juste. Although I do not have children, I enjoyed Boesky’s recollections of her daughters’ earliest days. Boesky obviously has a great sense of humor.

You don’t have to be Jewish to love Levy’s real rye.

And you don’t have to be an English major or someone with hereditary breast or ovarian cancer to enjoy this book.

Carpe diem!

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6 thoughts on “Hereditary Breast and Ovarian Cancer: What Slyvia, Pody, Gail and Elaine Had

  1. Carpe Diem indeed! Thanks for the great info thrown into a thoughtful review. I will look for this one.

  2. Elaine says:

    Katherine, Thanks for reading so much as you do, and for cluing me in about this memoir on a woman affected by a hereditary disposition to cancer. Each story matters -

  3. Anonymous says:

    Thank you for a very interesting post. I just discovered your blog from a link on BCmets.org and I am delighted to become one of your readers.

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