Exploring options to tackle cancer

Two years ago I wrote about my choice to have a preventive double mastectomy. A simple blood test had revealed that I carried a mutation in the BRCA1 gene. It gave me an estimated 87 per cent risk of breast cancer and a 50 per cent risk of ovarian cancer. I lost my mother, grandmother and aunt to cancer.

I wanted other women at risk to know about the options. I promised to follow up with any information that could be useful, including about my next preventive surgery, the removal of my ovaries and fallopian tubes.

I had been planning this for some time. It is a less complex surgery than mastectomy, but it puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine and mapping my hormones for estrogen or progesterone replacement. But I felt I had months to make the date.

Then two weeks ago I got a call from my doctor with blood-test results. “Your CA-125 is normal,” he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. But that wasn’t all. “There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer. CA-125 has a 50 to 75 per cent chance of missing ovarian cancer at early stages,” he said. He wanted me to see the surgeon to check my ovaries.

I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren. I called my husband in France, who was on a plane within hours. That same day I went to see the surgeon, who had treated my mother. I last saw her the day my mother passed away, and she teared up when she saw me: “You look just like her.” I broke down. But we smiled at each other and agreed we were there to deal with any problem, so “let’s get on with it.”

Nothing in the examination or ultrasound was concerning. I was relieved that if it was cancer, it was most likely in the early stages. If it was somewhere else in my body, I would know in five days. The day of the results came. The PET/CT scan looked clear, and the tumor test was negative. I was full of happiness, although the radioactive tracer meant I couldn’t hug my children. There was still a chance of early stage cancer, but that was minor compared to a full-blown tumor. I still had the option of removing my ovaries and fallopian tubes. I chose to do it.

Making the right choice

I did not do this solely because I carry the BRCA1 gene mutation. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options. Some women take birth control pills or rely on alternative medicines combined with frequent checks. The most important thing is to learn about the options and choose what is right for you.

In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer. My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother’s ovarian cancer was diagnosed when she was 49. I’m 39.

Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumor on one ovary, but no signs of cancer in any of the tissues. I have a little clear patch that contains bio-identical estrogen. A progesterone IUD was inserted in my uterus. It will help me maintain a hormonal balance, but more important it will help prevent uterine cancer. 

It is not possible to remove all risk, and the fact is I remain prone to cancer. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, “Mom died of ovarian cancer.” Regardless of the hormone replacements I’m taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life.

I feel deeply for women for whom this moment comes very early in life, before they have had their children. There are options for women to remove their fallopian tubes but keep their ovaries, and so retain the ability to bear children. It is not easy to make these decisions. But it is possible to take control . You can seek advice, learn about options and make choices that are right for you. Knowledge is power.