“Pretty is What Changes” is a personal account. The author described her experience of learning her risk of having hereditary breast and ovarian cancer and of the course that she decided to undergo prophylactic surgeries and how she defied her destiny.
Born as a pretty Ashkenazi Jew, the author had been raised in an elegant and artistic environment. Her grandmother was a dancer and her mother was a designer, who took great care of her body and image. The author’s sister was brilliant and beautiful too. Unfortunately, none of the ladies in the family avoided cancer. The author’s grandmother died of ovarian cancer. Her mother also passed away from ovarian cancer, secondary to breast cancer. The author underwent genetic test and found out she had BRCA1 mutation, one of the most deleterious mutation for both breast and ovarian cancers as well as cancers in other organs. The test results suggested that she had 87% risk of having breast cancer and 44% risk of having ovarian cancer in her life time. Due to her ethnicity, her risk is supposed to be higher than the number mentioned above. In this case, doctors would usually provide two options. One is the conservative approach, ie. frequent and close surveillance until cancer is found. Second approach is mastectomy and oophorectomy, cut off breasts and ovaries. To a young girl who was pretty and care about her image, and who desired to be married and had children, it was undoubtedly a big hit. Needless to say, breasts make a female visually and sexually appealing. Ovaries define a female and her reproductive competency. It is not difficult to imagine what a female would be like without these two critical organs. However, in the case of elevated chance of having breast and ovarian cancer, a pretty girl has to sacrifice her female image and reproductive ability to live. Of course, one could argue that reconstruction of artificial breasts nowadays look and touch very real. They are also sexually appeal to men. However, females who have reconstruction would feel nothing when being touched. Not to mention many women are so fond of and proud of their own breasts, like the author’s sister did. This is dilemma the author faced and the book is about her thinking process of making the decision of mastectomy, her emotional changes from being negative and frightened to optimistic as well as encouraging other women who have similar problems.
Life experience will definitely affect one’s decision making. The author witnessed how much her mother suffered during her last days of fighting with ovarian cancer. Her mother was a fashion designer, a delicate woman who desired a beautiful life. She hated chemotherapy because of the side effects of being alopecia. She had a hard time to let go at the very end of her life. One of the author’s girl friend was always optimistic though she had bilateral breast cancer and underwent mastectomy. However, her cancer spread to her lymph nodes, lung and bone. At the end, she was so devastated that she said her cancer was eating her brain and everywhere away. She didn’t even see her children when she died. Cancer is terrible. All of these, as well as talking to people on the website FORCE helped the author re consider about the priority in her life. Similar things happened to her sister. Her sister didn’t take any genetic testing until after giving birth to a baby boy. Unfortunately, she was also positive for BRCA mutation. She loved her own breasts so much that it was extremely difficult for her to decide mastectomy. However, she eventually got her breasts chopped off because she didn’t want her kid to live without a mother. Support from people with similar experience is important for someone to make a decision. Therefore, as a GC, we should learn the available supporting groups and provide the service one desperately needs.
Interestingly, the author also portrayed several doctors and a GC from a patient’s point of view. Unfortunately, not every health care provider described in this book presented a caring image to me. The way they talked to the patient was too matter-of-factly. Some statements were inappropriate. The GC, for example, said that the author’s mother was lucky to have breast cancer in her 50s. I understand that the GC must have seen a lot of patients who started suffering from breast cancer at their 30s even 20s. But none of patient is “lucky” only because she got it a few years later than someone else. The most interesting scenario was the plastic surgeon’s perspective regarding the size of the reconstructed breasts. The author’s breasts were size D which caused some troubles in her life and she desired smaller breasts like size B when having cosmetic surgery. But her male doctor seemed to insist her having size D. I don’t understand the underlying reason that the male doctor somehow forced his patient to have size which pleased him based on his personal preference. No wonder the author finally changed to a female doctor and got a perfect size.
The author wrote this book in a warm and humorous way. But I can feel the profound changes in her life during her decision making. As a future GC, we have to live with the fact that biotechnology is way out paced what we and ordinary people can deal with ethically. Our life would be woven with genetic discoveries and testing results. People nowadays can be truly defined by their genetic makeup. Their lives would be undoubtedly impacted by the development of genetics.
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