#FUcancer: When 1 in 8 Hits Close to Home

When I allow myself the rare glance backward to the dark early days of my cancer "journey," the memories around the core needle biopsy when my lump went from "probably nothing" to something deadly still have a sharp sting. Even though I had five surgeries that repeatedly cut away at my chest until there was nothing left, snipped and pulled my ovaries out through laparoscopic holes in my belly, and even a clean slice that took my uterus above the cervix, none of those procedures caused physical pain thanks to blissful drug-induced unconsciousness. But a hollowed out, fat ass needle with a pierce and cut mechanism housed inside that snaps loudly and excises tubular bits of tumor flesh while you are wide awake watching it happen was the pinnacle of pain for me, in part because I'm slow to numb and they didn't wait long enough before starting and also due to the visible horror on the faces of the radiologist and nurse as the picture of my tumor was frozen on the ultrasound screen and the cluster of rogue cells was stabbed, over and over again, as my still milk-filled breasts leaked in unison with blood from the excisional hole and my tears as we all apprehended the dire news that was to come. No wonder I leave that day filed away, deep in the old memory bank.

So cut to nearly a dozen years later, and there is my mom who so bravely tied my baby to her back Korean-style and cooked and cared for me while I underwent treatment for breast cancer now lying on the table, prepped and ready for her own core needle biopsy. A routine mammogram had come back suspicious, and she was immediately scheduled for next level diagnostics. I sat next to her while we waited for the procedure to start, the ultrasound photo of her irregularly shaped black blob resting deep against her chest wall, surrounded by a sea of healthy breast tissue, frozen on screen, staring us in the face.

"If you've had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average." --breastcancer.org

I have always known my daughters were at risk of getting breast cancer because of the family history I gave them and that their window of vigilant screening will need to start ten years earlier than when I was diagnosed. They are already prepared to face tough decisions in their early 20s, especially if future genetic screenings indicate they might benefit from prophylactic mastectomies (removal of the breasts before you get cancer), but I don't think they have any idea yet what the scanxiety will be like when they have to make a yearly trek for MRIs to screen their young dense breast tissue (because mammograms don't work until middle age) and then the waiting to hear whether their number is called or if they are free to live without worrying about cancer for another year. But in all my dedication to staying on top of current research and generally priding myself on being a font of information about breast cancer shared freely with everyone I meet, I missed something really important that I should have told my mom. If your daughter gets breast cancer, your risk doubles. If your daughter gets breast cancer before age 40, your risk climbs even higher. I was so focused on myself and my daughters that I forgot to worry about the reverse risk my mom faced.

Mama Kim was lying on the table, forlornly taking in the screen, and I thought of a great line of consolation. "At least you've been religiously going for mammograms every year, so at worst, this thing has only been growing to a worrisome size for 12 months!" She was sheepish and silent, then quietly admitted, "well...last time they say come again for checking two times in one week. So inconvenient. I skip last year because I go twice year before..." English is my mom's second language. This is how she sounds. I get endless mileage among my close friends retelling Kim-isms and imitating her forceful Tiger Mom way of seeing the world. But this admission made my whole body go cold, all humor draining away from the stubborn pronouncement typical of how she formulates decisions and lives her life, her way. "Was the area they rescreened in the same place!?" Her silence was my answer, and I realized once again that no one can really learn from someone else's experiences, regardless of how intimately they walked through it with you. Everyone thought I had taken one for the team because we had no family history before me. I kicked myself for not demanding to see the mammogram reports every year. I should have stayed on top of her breast health...what I went through should have been enough for all of us...

The radiologist came in and laid out her tools. I had a visceral reaction to seeing the core needle biopsy "gun" that shot through my tumor all those years ago. A sinking feeling came over me. I feared this would only be the first of many distressing moments of déjà vu to come. I watched the long needle slide effortlessly through six inches of normal breast tissue and then make a hard stop against a solid tumor. I observed the radiologist using extra force to pierce the mass and position the hollow point probe, and then I saw the samples being withdrawn and the scrunched up face of the nurse assisting who looked near tears as sample after sample was taken...and it was then that I realized this was going to have the same ending that mine had. No, "All good! Come back in a year!" for us.

When the biopsy was finished, bandages placed, and ice pack applied, the radiologist did something highly unexpected. Instead of the usual, "we'll call you with the results next week" delivered with a poker face that would indicate absolutely nothing about what "it" might be, she went far out onto a limb, balancing precariously on the "first do no harm" founding principle of medicine should her instincts be wrong and stated flat out, "I have to be honest...I'm worried about what I see. It looks cancerous to me. I think you need to prepare yourself." My mom was silent. I felt a strange calm come over me. I'd been inside this moment before, the free fall when someone pushes you over the cliff into the abyss of Cancerland, but this time I remembered to grab on and pull us to a ledge of safety where we could huddle together to find our footing and figure out the best path to climb back up. At least we wouldn't be starting from rock bottom...at least my experience would count for something.

We walked out to the parking lot, my tiny 5' tall mom suddenly seeming older, more frail, and more defeated than I've ever known this tough, war-surviving immigrant spitfire to be. The first words out of her mouth were, "maybe better to just leave in..." I flipped out and immediately rebutted, "what if I had said that 12 years ago?? I'd be dead, that's what." She calmly replied, "I'm old, you young, too late for me..." I gritted my teeth and understood she was processing the experience her way, but internally I was screaming, "oh, HELL NO!!" This is survivable. This is not the moment to give up. This is the time to let the devastating news sink in, yes, but it's the time to gear up to get it out and move on to the far more important business of making the most of the rest of her life. The confirmation from pathology came swiftly, and I was grateful for the advance preparation so that "your mom has cancer" wasn't shocking at all.

I'm pleased to report there has been a radical attitude change in just a few short days. I called my mom this morning and asked how she was doing, "I have ice cream for breakfast!" Good job, Mama Kim, that's the spirit!! And then, because nothing is ever good enough, she demanded, "Why they move so slow? Why not hurry up and cut tomorrow?" Sigh...on to phone calls and appointments, information gathering and translating medical speak...and appreciating the privilege of still being alive and the capacity to reach back through the fire and carry the most important woman in my life through to the other side, even if I might sometimes have to tie her to my back and carry her.