Feature

I am a one in twelve

One in twelve women in the UK will develop breast cancer, and almost everyone’s lives will be touched by it at some time. Yet for many cancer, and especially breast cancer, remains a source of fear and shame.
Here Joyce Wadler talks to Mandy Garner about her own experience of cancer, and why she wrote a book about it

There have been several personal accounts of struggles against breast cancer in recent years. Joyce Wadler is a journalist and her account, My Breast(now published in the UK by The Women’s Press) is a book she feels she couldn’t not write.

‘As a journalist,’ she says, ‘I know what makes a story and apparently it has struck a chord.’ Wadler originally wrote her story for a New York magazine as she thought it was ‘a very New York kind of story’ about a single career woman whose most important concern before she learned she had breast cancer was ‘getting a husband’ and working on her career.

The book’s style — full of brittle humour — and the professional journalistic polish make it seem as if you are not getting close to the real emotion, but it is never far from the surface.

The magazine article seemed to catch on and Wadler was commissioned to write a full brief. The paperback is out in the US and Wadler has just finished writing a filmscript of the book for CBS television. It will be shown later this year. The book has been published in six countries to date, and came out in the UK in April.

Wadler says she is astonished by the book’s popularity since there are many books on breast cancer, particularly in the US, land of self-help books and Oprah Winfrey let-it-all-hang-out panel shows. The book has been a particular hit in hospitals. Wadler’s favourite letter is from a woman who said it was the best present she had ever received. Another said she had read other books on the same subject, but Wadler’s had made her laugh.

It is very much set in the midst of Wadler’s life, work and relationships, giving a soap-opera feel as the reader gets to know the characters involved. Wadler says women feel they are ‘sitting schmoozing with a good girlfriend’. Readers commented that it ‘gives lots of information in a painless way’, although Wadler says she did not want to write a ‘medical-style’ book, since there were already plenty on the market.

Wadler’s journalistic background comes through not only in the pacy, humorous, dialogue-led style of the book, but also in her concentration on getting information across.

She first realised something was wrong when she felt a huge lump in her breast when she was in the shower. Although only in her thirties, she had regular mammograms since she had cystic breasts. But the mammogram had not picked up the lump. She had noticed her breasts were very painful, but had not thought anything more of it. According to her doctor, some lumps do not show up on a mammogram, including medullary cancer, from which there is around a 90 per cent chance of full recovery in 10 years. Wadler was diagnosed as having medullary cancer, although there was some nail-biting doubt along the line.

Wadler says the book’s main message is that she lived. ‘When people hear the word cancer, they think it equals death,’ she says. ‘When they know people who have had cancer and lived, it does not seem as frightening. ‘

In the US, one in nine women gets breast cancer. In the UK, the figure is one in 12. Hilary Clinton’s proposed changes to US health care are bad news, according to Wadler. Many employers are switching to health-managed organisations (HMOs) with insurers specifying that only doctors from the HMO organisation with which the company has a contract can be consulted. But Wadler says that it is very important women can choose their doctor or specialist. Women who don’t have health care insurance provided by their workplace have to insure themselves through Blue Cross. This costs around $3,000 per year. Those who have no work rely on government-financed Medicaid.

Wadler says: ‘When money is involved, the doctor can make recommendations for treatment based on profit rather than need. I had a letter from a journalist who did not have health insurance. She had a malignant lump. The doctor told her to have a mastectomy as it was cheaper than chemotherapy. She was horrified. She wouldn’t put up with this and eventually got help through Medicaid.’

Breast cancer is quite lucrative in the US, Wadler says, since it gets a lot of publicity. But it is only recently that legislation has been passed to regulate all mammogram centres. Before, they were self-regulating. This meant some centres were using machines that gave dangerously high levels of radiation; others did not take clear pictures and missed lumps.

Wadler says that mammograms fail to pick up 22-26 per cent of lumps in pre-menopausal women since their breasts are more dense and contain more glands. For this reason, it is only when women in the UK reach their fifties that they are routinely screened, whereas in the US there has been a push for screening to start at 40.

There are also concerns about the long-term side effects of radiation, with UK groups like Rage pressing for a public enquiry. Despite this, Wadler feels the mammogram is the best way to pick up lumps and believes it is worth ‘yelling and screaming’ to encourage work on improving the clarity of the image that mammograms can produce.

She gives many reasons why she may have contracted breast cancer: she was prone to cysts in her breasts; her father had died of prostate cancer; she was under stress. But none of these reasons alone seems to explain why she got breast cancer or why there is such a high rate of breast cancer in the US. Some studies suggest links with diet or lifestyle, but nothing has proved conclusive.

Wadler emphasises the importance of early detection and getting a second. Early in her book, she talks about a woman she knew who had breast cancer but left her lump for six months before doing anything about it. She told Wadler in obsessive detail about why she had thought she only had a tennis injury. Wadler writes: ‘Why is she telling us this? As the story dragged on it dawned on me: she was trying to justify to herself her delay in getting medical help. I also remember that she had been given as a room-mate a woman who was dying of breast cancer. The woman drifted in and out of consciousness, moaning, and I wondered how anyone could have made such an insensitive match. Within two years, my friend was dead too.’

Before writing the book, Wadler grappled with her journalistic ethics. She did not want to go ‘muck-raking’. Her journalistic credentials were mostly in crime reporting but her work was not sensationalist. She felt a responsibility to tell all the people involved in the book that she was going to do it, but they were all in favour. She changed a few things. What made the book interesting to her was the emotional problems. ‘I was not going for the well-adjusted award,’ she says. ‘I asked myself if I wanted to let everyone in New York know I was seeing a man who didn’t even want to come to the hospital with me.’

The book’s epilogue is written by Susan Love, a breast cancer specialist. Her tone is much more angry and political. Wadler says: ‘I’m me and she’s she. I’m glad there are Susan Loves out there being political, but I’m not a big organiser.

‘Susan says at the end of her piece that she hopes I will become more politically active but I don’t want to make statements. I would rather show people, look, you can have breast cancer and live a normal life. I am still a working reporter. I still have a small scar and I will probably have an early menopause, but apart from that I’m still working. I was terrified and it was the biggest thing in my life and it should have been.’

Despite this, Wadler has accepted invitations to speak at seminars arranged for the US National Breast Cancer Awareness Week.

Before she contracted breast cancer Wadler had done stories on breast enlargement and figured that that was what breast reconstruction meant. ‘I didn’t know it meant “goodbye nipple”,’ she laughs. Wadler advises people not to rush into mastectomy unless it is important.

Psychologically, she says her experience has not changed her much. She cannot live every day as if it were her last now that she is out of the shadow of the cancer, although she tries not to let trivia bother her.

Physically, she has put on a little weight. She thought the chemotherapy would make her lose her appetite and she would lose weight, but she didn’t and she is now pre-menopausal owing to metabolic changes caused by the treatment, so it will be harder for her to lose weight. However, she thought her body was cute before and she thinks it is ‘a pretty hot tomato’ now.

Wadler says there is a Dracula film out where Jack Nicholson tells Michelle Pfeiffer that ‘once you get past all the beauty stuff, you’re not interesting’. She, by contrast, is pleased to bear a small, but interesting, scar.

My Breast is published in the UK by The Women’s Press at £5.99.