Lives Flash Before Their Eyes
By Jacqueline Smiley, Certified Adult Nurse Practitioner, Hurley OB /GYN Associates
It was a regular evening at my folks’ house, just chit–chatting, making tea, and relaxing. My dad had on shorts, no shirt, just as usual.
As a nurse for many years, I see the human body on a daily basis. But, as a nurse, you don’t just see the body. Whether you intend to or not, you examine the body. Subconsciously, you look at the neck, the skin, the chest and abdomen, scanning for irregularities, changes, abnormalities.
And so on this evening, as I stood talking to my dad or Baba, as I call him, I noticed an unusual bump by his left nipple. The nipple looked like it was sticking out and puckering in at the same time. Instinctively, I reached over to touch it and, as I touched his skin, my fingers felt a hard,
irregular mass. It was about the size of an almond, fixed, non-movable and painless. That’s the exact moment I realized “IT” was in my family.
I was immediately transformed into a trance-like state. I entered a long,
dark tunnel and the faces of my aunts, grandmother, great grandmother,
great-aunt, and uncles appeared around me. The images were in black
and white and somehow in motion, seemingly vibrating in place. I could
hear my voice echoing, “it’s in the family, it’s in the family.” I knew right
then my father had breast cancer and it was in the family.
I’m not sure how long this out-of-body experience lasted, but my life
changed in that instant. I’d always known my family’s medical history.
I knew that we’d lost six relatives to cancer. Four women had died from
ovarian cancer, one from mixed breast and ovarian cancer, and one of
my uncles from lymphoma. I knew women in my family rarely lived
into old age, but I just figured it was due to poverty, poor health
insurance, and hard lives.
It was routine for me to discuss family history with my patients. I asked
them about their sons, daughters, sisters, aunts, uncles, parents, and
grandparents. Many times, I recognized the cancer trends and would
recommend genetic testing to determine if there was a gene mutation
that was responsible for the cancers. I asked all the right questions,
documented the histories and wrote out my recommendations to “refer
for genetic testing.” This went on for more than 10 years in my daily
clinical practice. Still, I did not recognize it in my own family.
I now fully understand denial. It is strong, blinding, and paralyzing. It
creates silence and causes death. It is extremely painful to look in the
mirror and see yourself for your deficits. To this day, I have to face my
responsibility, or lack thereof, and know that I could have prevented
illness and possibly death if it wasn’t for my own denial. So now I do
what I can, every chance I have, to tell my story with hope to save lives,
whole families or generations of families.
My Baba was lucky; his breast cancer had not spread past the lump in
his breast. His treatment was a double mastectomy, but he did not need
chemotherapy or radiation. He’s 78 years old now, healthy and vibrant.
It was his cancer that brought to light the fact that our family has a
BRCA gene mutation. BRCA is a gene we all carry. Some of us have
a mutation on that gene that increases our risk for breast cancer to as
much as 40-85 percent. It also increases the risk for ovarian cancer as
much as 16-64 percent. Other risks include prostate cancer, melanoma,
lymphoma, and pancreatic cancer. We can trace our family’s mutation
to my father’s grandmother. She died from ovarian cancer, as did both
of her daughters and three of her granddaughters. One BRCA gene is
passed down from each parent, so if one parent carries a mutated BRCA
gene, they have a 50 percent chance of passing that gene mutation down
to their children.
After my father tested positive for BRCA, my sisters and I were tested.
My younger sister and I tested positive for the mutation and my older
sister tested negative. I had already planned to do everything I could to
prevent cancer. I knew that the best way to prevent the cancer was to
remove my breasts and ovaries, and I sought help from my doctors to
set my plan into action. I became compulsively proactive, feeling the
guilt of too much time wasted already. Part of the monitoring process
when you are BRCA positive is to get a breast mammogram and breast
MRI annually beginning at age 25.
My first test, a breast MRI, was painless and easy. I went into my
oncologist’s office for the results a week later and had another out-ofbody
experience. I never expected anything but excellent results. I was
in the absolute best shape of my life. I had just completed the Chicago
Marathon and was running my best times ever. The doctor came in with
my MRI results in hand. All I could see was the dread on his face and
the yellow highlighted report. As he began to tell me the results, I was
looking around the room trying to figure out who in the world this man
was talking to. He could not have been talking to ME. And although I
momentarily slipped back into denial, I quickly realized there was no
one else in the room, and the MRI report clearly had my name at the top.
I was diagnosed with a grade 3, right breast cancer, two tumors, and the
cancer had spread to my lymph nodes. I underwent a double mastectomy,
chemotherapy, radiation, hysterectomy and six years of anti-hormone
therapy. I’m still here, telling my story and having fun running.
Thank God for modern medicine and research. I’ve conquered the
family curse and plan to live longer than any other woman in my family.
My younger sister was even more blessed. She had a preventative double
mastectomy, removing both her breasts, and they were cancer-free. She
had her fallopian tubes and ovaries removed to prevent ovarian cancer
and found out that her courage to prevent cancer was her saving grace.
Her results showed bilateral fallopian tube carcinoma in-situ. Cancer
was beaten again. Carcinoma in-situ is the stage just before cancer
spreads and kills women with fallopian tube and ovarian cancer. My
sister was 36 years old when she made that brave decision to have those
life-saving surgeries, and she’s also still living and loving life now at 43.
BRCA gene mutations, or Hereditary Breast and Ovarian Cancer
(HBOC), are in the spotlight now. Stars like Angelina Jolie, Kathy Bates,
and Christina Applegate are bringing attention to it by being open
about their own stories. All of us should discuss our family histories.
Families with breast cancer at early ages (under age 50), ovarian cancer
at any age, two breast cancers, male breast cancer, triple-negative breast
cancer, Ashkenazi Jewish ancestry, prostate cancer, pancreatic cancer,
melanoma or lymphoma are signs that a BRCA gene mutation or other
mutations that cause genetic cancers may exist. Once the signs are
recognized, testing is done by a genetic counselor or a provider that has
specialized training in genetic counseling. Testing is covered by most
insurance companies, and results can be back within a few days.
If a mutation does exist, treatment can range from having increased
screening tests like mammograms and MRIs and taking medication
to decrease the risk of developing cancer to having surgery to remove
breast tissue or hysterectomy to remove fallopian tubes and ovaries.
Treatment decisions are personal and diff erent for every person with a
BRCA mutation. Th e key is to have genetic counseling to learn about all
Once diagnosed, the knowledge can be used to prevent and treat these
cancers. It begins with awareness and the ability to face our fears. Denial
will not prevail. I live with a new appreciation for life and hope to share
my story and inspire others to learn about their family history, share
the knowledge, and prevent cancer or fi nd cancer that is early stage and
Hurley OB/GYN Associates provides a wide range of women’s health care services,
including genetic counseling and testing for hereditary b breast and ovarian cancer.