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Pink October

October in Maine is the time for beautiful shades of red, orange and yellow. The leaves slowly make their way to the ground in our final descent into winter. It is my favorite time in New England. Leaf peepers travel from all over to catch a glimpse of this yearly transition. This is also the time when the color pink aggressively forces it's way back into my life.

October is Breast cancer awareness month. It is important to educate that 1 in 8 US women will develop breast cancer in their lifetime. It is 2nd to skin cancer as most common cancer in American women with 30% of new cancer diagnoses. As such, there is a strong effort in health care to find these cancers earlier and provide resources for treatment. Death rates are decreasing in women over 50 years old and 3.5 million women have a history of breast cancer. These numbers are astounding. I don't need these numbers to know how important early surveillance and treatment is to a patient. I am what is sometimes known as a previvor. This means that my family history suggested my risk of breast cancer was higher than average and I elected to have a mastectomy as opposed to aggressive monitoring with MRIs, mammograms and ultrasounds. As a physician, I learned about suggested surveillance schedules for various cancers. We speak often of weighing risks and benefits when we decide frequency and modality of screening. We consider the anxiety and discomfort of the procedure versus potential for early diagnosis. I didn't appreciate the anxiety when I was younger. It seemed obvious to me that more testing was better.

Why would we withhold testing from anyone? It is always better to do more so we could save women (and men) from this deadly cancer. It wasn't until I found myself in a hospital waiting room shaking with fear before my first mammogram at age 35. I felt some abnormalities and my husband, and OBGyn, convinced me to come in and have a mammogram on Mother's day with my three children under three in tow. He moved some patients around and agreed to watch them so I could have this test. Why the urgency? It was probably nothing, right? Probably not. My grandmother died at 57 and my mother had stage 4 breast cancer. My cousins have endometrial and ovarian cancer. I sat in that waiting room with tears quietly running down my face and prepared for them to tell me it was finally my turn. My scans were negative but we repeated this dance several more times. The anxiety was crippling. I finally understood what I was taught so many years before.

My genetic screen was negative but my family history still haunted me. In 2017, my mother passed away at 64 years of age in my home on hospice. I was now my mother and my daughter assumed my role. As my mother endured 30 years before, I would now move on to raise my kids without my mother. My daughter lost her grandmother at the age of 7. The cycle continued. Soon after my mother's death, discomfort in my breast sent me back to the dreaded squeeze of the mammogram. After another negative result, it was time to break the cycle. I scheduled my mastectomy that day.

I had my mastectomy on Mardi Gras and my reconstruction on my wedding anniversary. It was the first surgery of my life and it was painful. I did not have to proceed to chemotherapy or radiation as others with a diagnosis of breast cancer but the surgery was the same. This is the journey of a previvor. We move forward and refuse to accept the continuation of this cycle. We were the caretakers of the loved ones we've lost. We've seen what cancer can do. We've felt the ripple effects and the profound loss. This is why Pink October is torture.

While I agree we need to spread knowledge and support those with this diagnosis, I wish it didn't have to be everywhere I went. There are pink hammers, cereal boxes, and headphones. There are banners plastered with pink and beautiful pictures of mothers and daughters hugging. In my practice, vendors send me pink flyers with pink gowns and gloves. I can tell you that no one cares what color their gown is when they are waiting for their mammogram. If anything, I wish it wasn't pink. October is a 30 day reminder of the loss of my mother and my grandmother. It forces me to remember trips to my mother's chemotherapy treatments as well as my own physician pain after surgery. It is inescapable. Previvors are often overlooked as a group. I completed a sprint triathalon 3 months after my reconstruction. I didn't belong in the survivors group but I needed support when it came to post-operative considerations and questions. Where is my tribe? I hope to help the cancer treatment and fundraising community to embrace a new model where we reconsider the war reference "survivor" that those that "lost their battle." We have a growing group of men and women that intervene early to prevent a diagnosis. These people likely cared for and lost a family member. I hope that we can consider the extended reach of cancer including those family members that are left behind and how they might prefer not to be reminded of their pain when they are trying to order toilet paper.

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