Had I Known

by Joan Lunden

  The room became suddenly and oddly quiet. You could have heard a pin drop when Dr. Calamari performed the procedure, searching and probing around the inside of my breast.

  Unfortunately, it wasn’t a cyst.

  Dr. Calamari calmly and softly said she had found a solid mass and was taking a number of snips to send to the pathology lab. She then informed me that she’d inserted a tiny metal clip, which would be used later, during a lumpectomy, to find and remove the tumor.

  There it was . . .

  That word . . .

  The one I didn’t want to hear.

  TUMOR!

  I had a cancerous tumor inside me.

  The doctor told me to get dressed and meet her in her office. I was lying there, still facedown, much as you do when you’re on a massage table, but this was anything but relaxing. My whole body was extremely tense. Being told I had a tumor growing inside my body felt like I was having an out-of-body experience. It was an insanely helpless feeling.

  The procedure hadn’t been as bad as I had imagined, but the result was so much worse than I ever could have dreamed.

  Welcome to my nightmare.

  I pulled myself up from the table, walked silently to the tiny dressing room, and mindlessly put my clothes back on.

  I didn’t want to feel panicked . . . yet . . . so I chose to feel nothing.

  I certainly didn’t want to think about the possibility of dying.

  No way was I going there.

  Jeff, who had come back from Maine for this procedure, was already siting in the office when I walked in. I don’t know if he could see the terror on my face or not. Dr. Calamari explained that the biopsy would tell us a lot more, but there was no doubt that I had breast cancer.

  Dammit, the proof was there, and there was no denying it.

  Time stood still for a moment.

  Some things in life are so surreal that your mind can’t process them easily.

  This was one of those moments.

  Now, I’m not the kind of woman to break down and cry. There have been occasions in my life when I thought maybe I’d be better off if I were that type—when I wished that I could just let go, be more vulnerable and sob, even a little. It’s exhausting always feeling the need to put up the strong front.

  However, this news went against everything I thought about myself.

  I was a healthy vibrant person!

  Wasn’t I?

  I felt instant guilt that I was putting Jeff in this situation.

  I needed to be strong and healthy for him and for all of my children.

  I wanted time to stay frozen, but the cruel reality was about to be laid out by my doctor.

  I wasn’t ready to hear it.

  And yet time stands still for no one.

  Once the pathology report came back, we would know the best course of action to take, but it would most likely require surgery and four weeks of radiation. There was always the possibility that I’d need chemotherapy, but it was too early to make that call, especially without the test results.

  Since it was Friday, I would have to wait the weekend to see where it would all land. Dr. Calamari had warned me that this was why she didn’t like to do these tests on Friday. But what choice did I have? I was in it now—deep.

  “Go about your weekend like everything is normal,” she said.

  But there was nothing normal about my weekend; I simply couldn’t get the thought out of my mind that I was facing c-a-n-c-e-r. I’d capitalize the letters here, but I wasn’t ready to give the disease that much power in my world—not then, not now, not ever.

  The thing about cancer is it doesn’t care about your plans. No matter how uptight and frantic I might have been on the inside, I needed to put on a brave face and pretend nothing was different, because we were hosting a couple dozen kids for Max and Kate’s birthday party the following day.

  Yup, we took several carloads of kids to a place called Bounce to celebrate Max and Kate’s eleventh birthday. This popular party place has more kinds of trampolines than you could ever imagine, and the kids jump and jump and jump around nonstop for an hour and a half and then end it all with cheese pizza and birthday cake. Seriously, just watching, up and down, up and down, up and down, is enough to make you want to puke. But they all love it, and that’s what counts, right?

  It was a time for wide-eyed smiles, candid photos, and celebrating. I looked at my children and thought, They’re so young and innocent. How will I ever tell them?

  I could feel a lump beginning to swell in my throat as I pondered, What if it’s really bad—like, terminal—and I’m not around as they celebrate these birthdays in years to come?

  Can’t go there.

  Don’t go there.

  STOP IT!

  Dammit.

  I don’t want to be sick.

  I don’t have time for cancer.

  Then I quickly realized I needed to get my head back into the party.

  I needed to be there for my kids.

  On Sunday we had another celebration planned: a combo birthday party for the kids and baby shower for Lindsay, who was expecting in early September. I’d been planning a midsummer baby shower for a larger group of women, but just about everyone in our immediate family would be in Maine on that date, so we took this opportunity to celebrate. Everyone there was family, and yet no one in the room knew anything about the stark reality of my cancer except Jeff and me. As soon as I began telling people, it would instantly become more real.

  I didn’t want that.

  And I didn’t want any pity.

  And I surely didn’t want to think of myself as a sick cancer patient.

  I wanted to remain quiet as long as I possibly could.

  But I felt like I was living in two parallel universes. One was happy-go-lucky, and the other was super-dark and scary, with potential for the worst-case scenario: early death.

  And boy, did I know something about sudden early death.

  My dad was a cancer surgeon and also an avid pilot; we flew a lot as a family, and we often accompanied him around the country as he spoke at medical meetings and sometimes assisted other doctors in difficult cancer surgeries. Our home in Northern California was literally built around an airplane hangar, with a taxi strip out to the runway of a small fly-in community.

  When I was thirteen years old, I watched my father take off on a short business trip to speak at a cancer convention in Southern California. He had asked my mom, my brother, and me to accompany him to the conference, since it was a brand-new plane. At first my mom said no, thinking that we shouldn’t miss school. But at the last moment, she changed her mind and we drove home. As fate would have it, just as we pulled up to the house, my father’s plane was lifting off the runway. We missed him by moments. I stood and waved goodbye, totally unaware that this was the last time I would ever see my father. His plane crashed in Malibu Canyon as he was returning home from that medical convention with another cancer specialist.

  But my dream to follow in his footsteps lived on.

  CHAPTER 3

  I Thought It Could Never Happen to Me

  I had a false sense of security about cancer. It won’t happen to me. Well, you know what? It did! I feared for my life, and then for my career, but I learned that it helps to turn fear into action.

  DIAHANN CARROLL

  Actress, diagnosed in 1997 with breast cancer

  Accepting that you have a potentially deadly, fast-growing type of cancer in your body is nothing short of surreal.

  How did this foreign mass, this tumor that was out to kill me and spreading its venom with each passing moment, get inside me in the first place?

  Had I done something?

  Taken something?

  Eaten something that had brought this on?

  I couldn’t help but wonder how I’d brought this on myself.

  While I didn’t have time for self-loathing or self-pity, I definitely found myself looking back and wondering how it had happened to me. What action
s did I have to take responsibility for that might have brought this on?

  We’ve all heard the saying “Ignorance is bliss.” Well, that was the only explanation or excuse that I could conjure up when trying to justify why I had always felt immunity from breast cancer. While I have been a broadcast journalist for over three decades, I am going to be completely candid and let you in on my totally lame rationales and the absurd reasons I believed I was never going to get breast cancer.

  At the top of my list was the belief that since I am a health advocate for women and spend most of my time crisscrossing America to address crowds about staying healthy and ways to increase their longevity and avoid deadly diseases, I couldn’t be affected by anything I was talking about.

  No way!

  I somehow convinced myself that since I was out on a speaking circuit, telling others how to avoid disease through exercise, nutrition, and making better lifestyle choices, I somehow got a free pass.

  Don’t even say it.

  It was pretty bold and, yes, overconfident.

  This next reason is for your personal amusement: I actually felt I was somewhat immune because my father had been a cancer surgeon. Okay, I get it; it’s kind of like thinking if your father is Steve Jobs, your computer won’t get a virus.

  While I recognize that what my father did for a living didn’t earn me a get-out-of-jail-free card, it often brought up the issue of my family medical history. For as long as I could remember, I had contended that there was no significant history of breast cancer in my immediate family; therefore, breast cancer happened to other women.

  Logical, right?

  In reflection, why did I think that?

  Had I known that only 15 percent of women diagnosed with breast cancer have a family history of the disease, I probably wouldn’t have been so quick to run with that stance. When I discovered this ASTONISHING statistic, I felt so left in the dark. How was it possible that, after years of being an educated health advocate, I had no idea that such a small percentage of women could use their family history as an indicator?

  Something wasn’t right! If I wasn’t aware of that information, surely others were as in the dark as I was.

  And the more I thought about it, was I really so certain that I didn’t have any breast cancer in my family medical history? I hadn’t heard of any, but now I was questioning whether I knew this for a fact. My family never lived close to any of our relatives, on either side of the family, so I hadn’t spent much time with any of them and consequently hadn’t been privy to casual family conversations between grandmothers and aunts. I was a child. I didn’t keep up with who had what illnesses. Looking back, I can’t say why I was so adamant that breast cancer didn’t run in my extended family. I had no facts whatsoever to back that statement up. That’s the first rule they teach in journalism school: Facts first, story second. And yet I continued to answer that question the same way, over and over.

  It made things easier to rationalize when I decided to take hormone replacement supplements so I didn’t have to suffer from hot flashes, sleepless nights, and all the other not-so-fun symptoms of menopause.

  I call this the ultimate “inside job,” because I was telling myself I had nothing to worry about. While I had heard there could be some elevated risk of developing breast cancer from taking hormone replacement during menopause, when I assessed the pros and cons, anything that made life more comfortable was fine by me, even if this justification had potentially dangerous consequences.

  Wow!

  Who was I fooling, anyway?

  Who was I putting one over on so I didn’t have to suffer hot flashes?

  Yeah, I know hot flashes suck, but in retrospect, possibly dying sucks a lot more!

  Some of my friends and family raised an eyebrow or two when I shared that I was taking hormone replacement therapy to minimize my symptoms. And while I’ve been told that taking HRT all those years may have had absolutely nothing to do with my developing breast cancer, unfortunately, once you’re diagnosed with the disease, it’s hard not to beat yourself up and wonder if every bad decision you’ve ever made along the way, from drinking diet cola to lying in the sun, has finally caught up with you.

  So what are some of the other risk factors that I should have been concerned about?

  Duh!

  They were so basic that I essentially overlooked them.

  For starters, getting older tops the list. While we all know it’s inevitable, we never really anticipate the impact. Acording to the American Cancer Society, about one out of eight invasive breast cancers develop in women younger than forty-five. About two out of three invasive breast cancers are found in women fifty-five or older. In fact, the aging process is the biggest risk factor for breast cancer. That’s because the longer we live, the more opportunities there are for genetic damage to occur in the body. And as we age, our bodies are less capable of repairing genetic damage. That’s why it’s so important to take care of ourselves by eating right, exercising several times a week, maintaining a healthy weight, not smoking, and living a healthy lifestyle as we age. I’d always thought I was doing this. Had I known that the choices I’d been making before I was diagnosed weren’t all the right ones, I would have changed things a long time ago.

  But more on that later.

  Next is dense breast tissue. About 45 percent of women aged forty to seventy-four have dense breasts. The younger you are, the denser your breasts are. Dense breasts have more fibrous and glandular tissue than fatty tissue, which can make it difficult for a radiologist to detect cancer on a mammogram. Dense tissue, like cancer, shows up white on the mammogram. Fatty tissue is dark, so any cancer is more visible. While I was aware that I had dense breasts, and that made it difficult to spot and diagnose cancerous tumors without an ultrasound, what I didn’t realize was that women with dense breasts have been shown to be four to six times more likely to develop breast cancer. Only age and the much-talked-about BRCA1 and BRCA2 mutations increase their risk more. And since I’m mentioning BRCA1 and BRCA2, these are human genes that produce tumor suppressor proteins. According to the National Cancer Institute, specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer. Together, BRCA1 and BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancers (1) and about 5 to 10 percent of all breast cancers. In addition, mutations in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers overall. Breast and ovarian cancers associated with BRCA1 and BRCA2 mutations tend to develop at younger ages than their nonhereditary counterparts. A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50 percent chance (or 1 chance in 2) of inheriting the mutation.

  While experts say that having children past the age of thirty poses a slightly increased risk of developing breast cancer, I didn’t really consider it to be a huge contributing factor, though I had my first child when I was thirty and two more before I turned forty. All three of those pregnancies were naturally conceived, making the risk very low. In the scheme of contributing factors, this wasn’t one I could give a lot of weight to.

  On the other hand, extended exposure to estrogen and progesterone was something I needed to consider as a possible factor. You see, like a lot of women of my generation, I had such terrible menstrual cramps as a teenager that I was given birth control pills to help regulate my periods. I continued taking them until I was in my late twenties and began trying to get pregnant. Throughout the course of my adult life, I took oral contraceptives until I reached menopause.

  When I married Jeff, he and I went through two years of fertility treatments—several rounds of unsuccessful in vitro fertilization—pumping all sorts of hormones into my body, trying to conceive a baby together. When we weren’t able to conceive, we turned to a surrogate to help us build our family, and I went directly on
hormone replacement therapy.

  Of course, I didn’t look at this buildup as a problem over the years, but it probably had some kind of impact. I suppose I’ll never know, and really, what’s the point of trying to figure it out now anyway?

  I’m going to let you in on a little secret.

  Promise not to tell anyone?

  In spite of my love of fitness, there were long periods in my life when I did absolutely no exercise at all.

  Damn!

  I never thought that one would come back to bite me in the butt—or should I say boob—in such a big way.

  It turns out that lack of regular exercise can impact the likelihood of developing breast cancer. So the next time I’m lying in bed, deliberating whether or not I should get up and hit the gym, you can bet I’m going to move my ass!

  Thankfully, I’m what most people refer to as “a cheap date.”

  Why?

  I don’t really like the taste of alcohol.

  Other than a glass of good wine every now and then, I can live without booze, so consuming alcohol, which can be an indicator for developing breast cancer, wasn’t a real issue for me.

  And just when I thought I had escaped the wheel of cancer roulette, it’s as if someone blurted out: “But wait, there’s more!”

  It’s not like I bought a set of Ginsu knives.

  (Gee, wouldn’t that have been nice!)

  As researchers learn more about how cancer cells develop, they are concluding that there are several other stressors on our immune system that may be important risk factors for developing cancers, including breast cancer.