A thread about #BreastCancerAwarenessMonth

I never thought much about breast cancer when I was younger.

My mom died of ovarian cancer when she was 52.

My grandmother was diagnosed with breast cancer but she was old and had Alzheimer’s. I wasn’t worried.

1/

But then in 2010, my first cousin once removed - also a college professor, coincidentally - died of metastatic breast cancer. Melanie was 44 years old. I was 38 at the time.

2/

Early that year, I’d had a minor scare: a mammogram and ultrasound of a teeny tiny but palpable lump had been flagged as concerning. I had a stereotactic biopsy. All good.

Months later, another lump, another round of tests. All good.

But the seeds of worry had been planted.
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When Melanie died, those seeds were watered and grew.

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2011 rolled around and I had another lump. Ultrasound, MRI, biopsy, and then a lumpectomy.

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The pathology report came back and things looked....good-ish. The mass was benign but it had some odd features and they were unable to get clear margins. My surgeon said not to worry.

6/

But I was worried. I kept thinking about Melanie. And my son. And my wife.

I asked my surgeon if she could send the tissue samples to another pathology lab for a second opinion. She was kind and patient and said absolutely.

7/

The second pathology report was different.

The pathologist thought the mass had features of a phyllodes tumor. Not malignant but “borderline”

Neither pathologist made a mistake - pathology is both art and science and sometimes opinions differ.

8/

I was worried. My surgeon suggested a second lumpectomy to try to get clear margins. We talked about risks and benefits.I was BRCA negative but the geneticist the surgeon sent me to had concerns about my family’s patterns of breast and ovarian cancer.

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Intellectually I understood that another lumpectomy followed by watching and waiting would probably be fine. But emotionally, I was a wreck. For me, “watching and waiting” meant living with the crushing weight of worry.

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My surgeon listened to me and talked to me about options. I told her I’d rather have a prophylactic mastectomy than deal with the anxiety associated with an annual mammogram-ultrasound-biopsy merry-go-round.

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She more than listened to me - she *heard* me.

Exceptional surgeons don't just cut. They care.

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I had a prophylactic mastectomy without reconstruction in October 2011. No hospital stay - I went home the same day.

Never once have I regretted my decision.

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I'm sharing this story because it's important to recognize that there isn't a "right" way to navigate decisions when it comes to your own breasts.

They are *your* breasts.

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If someone wants to make their breasts bigger, it's easy to find a surgeon willing to do it.

If someone wants to remove their breasts -- whether to reduce their risk of breast cancer or to bring their body into alignment with their gender identity - it's not so easy.

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I was fortunate to find a surgeon who understood that my need to avoid breast cancer was infinitely greater than my desire to have breasts.

I'm so grateful for that.

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So, for #BreastCancerAwarenessMonth, here are a few things to know:

Anyone with breast tissue -- regardless of sex assigned at birth or gender identity -- can get breast cancer.

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We need more research on metastatic breast cancer.

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Breasts mean different things to different people. If a person with breast cancer wants reconstruction, that's great. If they don't, that's great too.

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The absence of breasts on someone who identifies as a woman doesn't make them less of a woman.

Similarly, the presence of breasts on someone who identifies as a man doesn't make them less of a man.

20

Thank you for coming to my TED talk.

/end thread