The chance of getting breast cancer in your 30s is 1 in 250. I am 33. I was unlucky.
My diagnosis of invasive ductal carcinoma comes with a dream buster: If I survive, there is a high chance that I may not be able to have children.
“Your ovaries will suffer during chemotherapy,” warned Dr. Tihesha Wilson, a breast surgical oncologist at Mercy Hospital, after explaining a course of treatment. “You can develop premature ovarian failure or early menopause.”
The room got smaller. I thought about my childhood dream of one day falling in love, having a pretty wedding and giving birth to a boy who looked like his father. I felt like I had been robbed.
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In a twist of irony, my choice to delay motherhood had also put me at risk for breast cancer, in the eyes of some experts.
“For over two centuries it was believed that a major cause of breast cancer was women not using their breasts for their natural purposes,” said Valerie Beral, director of the Cancer Epidemiology Unit at Oxford University. I watched her 2010 lecture on YouTube that night.
Information from more than 50,000 women worldwide, Beral said, has shown that the risk of breast cancer decreases with the more children women have and the longer they breastfeed. The higher incidence of breast cancer in developed countries is largely due to the different childbearing and breastfeeding patterns, Beral said.
No one in my family has had breast cancer. In Colombia, my maternal grandmother had seven children. My paternal grandmother had nine. They breastfed all their children. Neither grandmother finished high school.
“Take advantage of the opportunities that I didn’t have,” said my maternal grandmother. I was 18, and my teenage cousin had just given birth to a boy. “Condoms. Pills. Use those,” she said. I giggled.
My grandmother didn’t know that taking contraception increases the risk of breast cancer. I didn’t take the pill, but I did promise her that I would fly around the world like a free bird and have a career before I considered marriage and pregnancy. I thought I had arrived at that place in my life. My plans were crushed.
To complicate the situation, my fertility options without a male partner were limited. I learned from the Young Survival Coalition that only about 500 babies have come from frozen eggs, and only a few from ovarian tissue freezing. Also, both fertility preservation methods are experimental, so they are generally not paid for by insurance.
With a tsunami of medical bills on the horizon, the treatments would bring an extra burden. Either one would cost at least $10,000 for each cycle and hundreds per year in storage costs.
The process could take about three weeks. And with a Stage 3 time bomb threatening to explode through my lymph nodes, delaying chemotherapy did not feel like a wise choice.
Fertile Hope, an organization dedicated to disseminating information on infertility associated with breast cancer treatment, places the risk of infertility due to chemotherapy at 40 to 80 percent. With some regret, I decided I was going to take a gamble.
My primary mission was to work on saving my life. A representative of the American Cancer Society said that patients with my diagnosis had a 67 percent chance of survival, and explained over the phone that the numbers did not take into account lateral health conditions. I was healthy otherwise, so I assured myself that my chances were higher.
The course of treatment, Dr. Wilson said, would require chemotherapy, removal of my left breast, radiation and reconstruction surgery. Dr. Robert DerHagopian, medical director of Baptist Health Breast Center, said the initial surgery would depend on the size of the tumors in my left breast after chemotherapy. I would also have to consider pending results of a genetic test. A lumpectomy, the removal of the cancer, and not the entire breast, could also be a possibility, he said.
Even if my ovaries were unharmed from chemotherapy, Wilson explained that I might have to undergo treatment with Tamoxifen for five years to prevent a recurrence. Animal studies have suggested that the use of Tamoxifen during pregnancy can harm a fetus.
Friends and colleagues who learned of my perils introduced me to a team of breast cancer survivors.
One had a hysterectomy to minimize the risk of contracting ovarian cancer. She talked to me about adoption.
“There are many ways of having a family. Adopting my daughter is the best thing that could have ever happened to me,” she said. “I love her just as if I would have given birth to her.”
A 33-year-old mother of a biological daughter, who had hoped to have a second child after finishing college, said her diagnosis was devastating, but her period returned.
“It is one of the worst situations a woman our age could face. We shouldn’t have to be dealing with this. We are too young,” she said. “You just have to know that you will survive. You have to be convinced, and know that your life will be as wonderful as you want to make it when all of this is over.”
But who would want to marry a woman who couldn’t bear a child? Another survivor who fell in love during her treatment warmed my heart with her story.
“I don’t think my husband would be in my life if it weren’t for this experience,” she said. “I know you feel like your life is over, but it’s not. Don’t worry. You are going to survive this, and love will come.”