“My paternal grandfather had breast cancer.”
That tends to make whoever is charting my medical history look up. “He had a radical mastectomy in the 1970s. And his sister had it, too—she died in her fifties. And one of his nieces. And his daughter—my aunt.”
I’m sitting in the genetic counselor’s office as she madly sketches out my family tree on a sheet of paper. There are squares and circles, the cancer victims marked with X’s. Lots of X’s.
On my mom’s side: cancer in both her parents, although not breast. An early melanoma in her sister. And less than six months after this conversation, my mom herself will be dead from a blood cancer called multiple myeloma.
As the genetic counselor is drawing the diagrams, I am remembering a similar one from seventh-grade science class, the Punnett square: almost fortune-teller-like, better than Ouija boards and those folded-up cootie-catchers—when the grown-up self is almost equally conceivable and impossible. Pick any boy in the class, and you could predict the likelihood that you and he would have kids with brown eyes or hair on their toes and fingers. Or—as the genetic counselor’s diagram seems to suggest—cancer.
According to the Punnett square, two kids at my table, Mike Henninger and Christina Stapleton, had a 100 percent chance of having a blue-eyed baby. This thrilled seventh-grade me: Something about the future was settled, then. A certainty—if Christina and Mike fall in love. And want a child. And Christina is able to get pregnant. And the baby arrives safely into the world.
On my dad’s side: His older sister has the breast cancer mutation BRCA2. She was the first of us to be tested, after her diagnosis in the 1990s. Her daughter, who has not had cancer, also has the mutation. And so does at least one of my dad’s three living brothers.
But it turns out I do not have it. I have just been diagnosed with breast cancer at age thirty-seven, but I do not have the breast cancer mutation.
“I’m going to send you a study I found,” the genetic counselor tells me. “You might be interested in the findings, given your situation.”
Researchers have discovered that in families where there is an identified breast-cancer-gene mutation such as BRCA1 or BRCA2, even family members without the mutation are at a greater risk for developing the disease.
“All this likely means is that there are some genes we have not successfully mapped yet,” the counselor says. “We are seeing part of the picture, but not all of it.”
We are certain only that there is so much of which we are not certain.
As far as we know now, genetics accounts for only about 11 percent of all breast cancers. Which leaves 89 percent hurtling randomly toward us through outer space.
My grandfather, the one with breast cancer, died when I was seven, two years after my grandmother. Cancer, both of them—his maybe metastasized from the breast, maybe something else. We can’t be sure—it was the early 1980s.
“Did you ever see his scars,” asks one of my uncles after my diagnosis, “from the mastectomy?”
Once I did, although at the time I thought they were from a war. It was summer. I was five or six years old and we were down on the rocky beach below our family summer house on Cape Cod, where my grandmother’s horse, Sachem, had caught a leg between two large rocks, snapped it with the force of his own heaving and had to be shot. The horse’s body was too immense to move, and everyone was sweating from the work of covering him with a mound of rocks piled taller than me.
My grandfather’s body was lean and muscled and rigid—the familiar family physique—but his bare chest was another planet: distorted, twisted with scar tissue, hollowed out to the rib cage like a wooden-hulled skiff.
Grown-ups are full of surprises, I remember thinking. Who could ever possibly imagine what it is to be one?
Years later, farther down the beach where the bluff curls to a weedy cove, some of Sachem’s bones eventually returned to us—bleached, worn, and so massive at first I imagined they belonged to a prehistoric beast. Now one is kept on the table near the mantel, next to the angry jaw of a bluefish, the slough of a king snake, a brittle helix of thousands of conch eggs and two wooden plaques carved with my grandparents’ dates.
Some things are meant to return to us again and again.