The word cancer comes up often. More so than I ever noticed before this year. We tan and joke about skin cancer, smoke and rib each other about lung cancer in our future. In my classes, we discuss how environmental racism causes certain groups to be exposed to carcinogens more than others. In television shows and movies, the word cancer is tossed around ad nauseam. We hear about celebrities dying of cancer. Over half of families in the United States have been touched by cancer.
In January, I sat in my dorm room and listened to a nurse practitioner tell me over a telehealth call that I am BRCA1 positive. I remained stoic as she explained that by age 50, I have a 28% to 51% chance of developing breast cancer, as compared to 2% for those without the BRCA mutation. I began tearing up as she said that by age 70, the risk will grow to 46% to 87%. And I cried learning that I will likely need to have a double mastectomy and removal of my ovaries and fallopian tubes within the next two decades of my life.
Throughout the next month, I did not stop thinking about this diagnosis. I began cutting out red meat, as its consumption is linked to a heightened risk of breast cancer. I stopped smoking cigarettes entirely, yielding questions from my peers on nights out. I exercised compulsively, attempting to attribute the constant tightness in my chest to my cardio routine. And while I tried to deal with it rationally, I became overly emotional about everything in my life, and felt intensely guilty for it.
The issues we deal with in college are mostly predictable. We stress over poor grades, cry over failed situationships and gripe about post-graduate plans.
I tried to be open about my diagnosis. I told most of my friends, though mainly to explain away my constant emotional state. But after a few weeks, I just felt as though I was overreacting — and above all, that I was helpless.
Women with a heightened risk of having the BRCA mutation, primarily driven by family history, are encouraged to be tested at age 25, as that is the age at which intensive breast cancer screening begins. Before that, there are few effective prophylactic measures to take.
Because of this, it is generally uncommon to learn of such a diagnosis at 21, as I did. For the next four years, there is little to be done beyond just carrying the weight of this knowledge. I wake up thinking about it. The body I have grappled with wanting to change and working to love suddenly feels like something I will lose.
A friend of mine forced me to shift my mindset about the next few years. Having experienced a somewhat similar issue, she had been able to see the silver lining in our diagnoses.
“[Right now,] your mindset [is] ‘there’s nothing I can do, this is out of my control,’ existential dread. I know it’s super hard, but you need to switch that to ‘this is out of my control — weight off my shoulders for now.’”
For weeks, all I wanted was to return to the person I had been during Half Block, during fall semester, during freshman year — while I have carried this genetic mutation all my life, I wished that I could have remained oblivious to its existence.
And yet, months out from coming to terms with this reality has forced my perspective to shift. Mutations in the BRCA1 and BRCA2 genes are rare, affecting roughly 0.2 to 0.3% of the general population. Among Ashkenazi Jews, of whom I am a descendant, the prevalence increases to 2.5%.
And so while I am unfortunate to be in this situation, I am also incredibly lucky to know I am aware of it. Of the hundreds of thousands of Americans living with the BRCA mutation, only 10 to 18% are aware that they have it. My aunt Nina, who passed away from ovarian cancer in 2021, was not afforded the knowledge and subsequent preventative measures I will take. The same goes for thousands of others, predominantly women, who did not have the chance to undergo genetic testing for this mutation.
Finding this silver lining, along with my friend’s words, is what has gotten me through this. I’ve resorted to repeating clichéd mantras: knowledge is power. Control what you can, accept what you can’t. And most of all, the only way out is through.
I wake up in the middle of most nights now, thinking about my future in a panic. I worry for my sibling, who has yet to be tested and has a 50% chance of being BRCA1 positive as well. Amid the cracks about skin cancer that I laugh along with, I feel intensely guilty anytime I get sunburnt. Three months out from my diagnosis, I feel ashamed for its continued imposition on my schoolwork, social life and mental health.Many people in my life have told me that I am an overly emotional person. I don’t doubt that is true — the things I care about impact me more heavily and lengthily than they would for many people. But similar to emotionality in politics, this attribute does not antithesize logic and reason. I can approach this predicament with the knowledge of its existence and the ability to take preventative measures against it. I can recognize the inequities in insurance for women with the BRCA mutation, who are usually denied coverage for biannual breast cancer screening following prophylactic mastectomies, despite cancer risks persisting. And I see how this experience, unlike most in my life, will stay with me not as a part of my past but always as a risk of my future.