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Staying Alive

In 1995, a bilateral prophylactic mastectomy (having both healthy breasts removed) was psychologist Janet Reibstein’s choice for survival. Staying Alive (Bloomsbury, $24.95) is Reibstein’s family memoir, told as both a personal journey and a history of current breast-cancer knowledge, treatments and women’s attitudes. In this book we learn how and why she arrived at her dramatic decision.

They were three close, loving sisters— Mary, Fannie and Regina Smith, born between 1912 and 1920—daughters of Jewish immigrant parents. Tragically, all three were diagnosed with breast cancer: Fannie (“sharp-witted, steady, and puzzlingly frail”) at 32, Regina (“ambitious, brainy”) at 43, and Mary (the “sweet, careless one”) at 55. All three eventually succumbed to the disease.

Janet, Regina’s daughter, tells of the impact of the disease on the sisters’ personalities, their sibling relationships, their marriages, their children, and—in Regina’s case—professional life. The story is heart-wrenchingly detailed. At its very essence, however, this cautionary account is a chronicle of an intense relationship between mother and daughter, bound by love and a genetic “curse.”

In the sisters’ era, women’s breasts were perceived for the most part by women and men as sexy, aesthetic and pleasurable. Breast cancer was thought to be an older women’s disease, and one only whispered about. Mammograms were unheard of, radical mastectomies were the norm (and had been since the late 19th century) and there was no knowledge of breast-cancer-causing mutated genes.

After her cousin Joyce was diagnosed in her late 40’s, when Janet herself was 48, Janet’s breasts became, in her own mind, her “enemies.” After investigating the possibility of preventive mastectomies for over 20 years, her decision was fortuitous; when she thought she was having elective, preventive surgery, she did in fact have carcinoma-in-situ. Her breast cancer story is one of hope, survival and taking charge.

As an almost 11-year breast cancer survivor myself (we all seem to remember the exact dates we were diagnosed), with a breast cancer family history, and as an informed medical consumer and advocate, I have yet to confront the genetic predisposition possibility. I’d always thought that, since I was childless with no familial legacy, I didn’t need to know my genetic status. This book makes me rethink my options.

Ann Jackowitz is Executive Director of the Samuel Waxman Cancer Research Foundation in New York City.