Last month, I turned 40. Forty is a major milestone for most women: some look to it with dread, and some look to it with excitement and a bring-it-on mentality (the Twitter hashtag #thisis40 illustrates both aptly). Many female celebrities are embracing 40 and making it look oh so good, serving as positive role models for the rest of us; we even have our own magazine now.
Forty is also when many women schedule their first mammogram. Despite recent controversy over the American Cancer Society's changes in the recommended age for beginning annual breast x-rays, many women I know still think of 40 as the year of the mammogram; as several of my friends have turned 40 in the last year, they have had their first mammograms. Almost every one of them has had some sort of question for me about their experience: "Is it unusual that xyz happened?" or "Why did they do abc?" They come to me with these questions because they know that I had mammograms for eight years, between age 27 when I learned that I am BRCA2+ and when I had a bilateral mastectomy after being diagnosed with DCIS at age 35. It's a bit odd being known for my mammogram "expertise," but I'm glad I can help ease my friends' anxieties.
Because I'm not thinking about that nerve-wracking first mammogram, this birthday has prompted me to reflecton the last mammogram I had – back in 2012 - the mammogram that changed my future, one of the scariest and most surreal events of my life. Despite important questions about whether they really are saving lives, mammograms are considered to be life-saving for women in their thirties with BRCA mutations. Specifically, because of my age and my genetic mutation, without the mammogram I had one week after my 35th birthday, it is possible that I may not have made it to my 40th.
But because of that mammogram, my thirties were not so fun. I faced by far the most difficult physical and mental challenges of my life as I went through and recovered from three major surgeries related to my BRCA mutation. Because of the mutation, my insurance company had to pay for yearly mammograms before I was 40 years old, and I probably wouldn't have had them otherwise. The kind of DCIS I had could only be seen on a mammogram.Although nearly 100% of DCIS is curable, my DCIS was Grade 3: the most likely to progress to invasive cancer and/or return within five years. There were tumors in nearly half of my breast tissue, and they contained comedonecrosis, evidence that they were growing quickly. It seems pretty evident that had I not had that mammogram (and the proceeding bilateral mastectomy), those cells found in my right breast four years ago could still be growing today, they could have spread, or a second cancer could have developed.But now, instead of a yearly mammogram at my birthday, I have an annual appointment with my breast surgeon for an exam – palpitations by hand – and for the third consecutive year, everything was just fine.
I have often felt cursed by my genes, especially when I was diagnosed with DCIS, and especially when I was recovering from those surgeries. When members of our family have been ill or died from cancer related to BRCA, I have sworn up and down at my genes. But, perhaps now that I'm officially in my forties and I'm trying to look at the world through the lens of appreciation rather than cynicism, I realize that maybe I should be thankful for the mutation; while it may have almost killed me, it also saved me. For me it will always be the year of the mammogram – every year that I'm alive.
Bryna Siegel Finer tested positive for the BRCA2 mutation at 26 years old and, after seven years of screenings, a mammogram discovered DCIS in her right breast. Bryna teaches writing at Indiana University of Pennsylvania and lives in Pittsburgh with her husband, who is BRCA1 positive, and their son. She is a peer support group co-leader for FORCE Pittsburgh and can be reached at email@example.com.
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