It’s Breast Cancer Awareness Month. This is the month when everything turns pink—in the grocery store, on the football field, at my gym, at school fundraisers, in every sales pitch I get over text or email, literally everywhere. Pinktober is here, in full effect.
For me, though, it’s always breast cancer awareness month. I’m always aware of the disease, all day, every day, because In November 2017 I was diagnosed with breast cancer after a routine mammogram at the American Radiology on Fleet Street. It came as a total shock—I never expected those routine tests to catch anything. But they did—an 8mm tumor in my left breast, at the 10 0’clock position, a couple inches north of my nipple. I thought I understood the disease before this happened. My mom has been through it twice, two aunts, a lot of friends, and every October I was reminded to be aware of it. But I had no idea what breast cancer really meant.
Here are a few things I’ve learned over the past couple of years that I’d like to share with folks as we “celebrate” this month. It’s not about “saving the ta-tas.” It’s about saving people, human beings. All of us have breast tissue, and that’s all it takes to get breast cancer. This month we’ll see lots of images of cheerful cisgender women who are all smiles, but that’s not the reality—people of all genders get breast cancer, and treatment does not make anybody smile.
It is absolutely brutal, and whether or not it saves you is largely up to chance. Except that it’s not, at least not altogether. It is true that there is no way to predict whose cancer will metastasize—spread beyond the breasts and lymph nodes to other parts of your body. This is something I never really understood about breast cancer: once they find the tumor, there’s already a chance cancer cells have moved through your body and taken up residence in your liver, bones, lungs, brain, or somewhere else. If they wake up and grow, you’ve got metastatic breast cancer. The chance of making it to five years once that happens? Around 25%. Some say it’s a chronic condition, but that doesn’t sound chronic to me. That sounds terminal—the end, death.
Some factors in one’s favor to not metastasize and die? Being white, and having access to advanced medical care. Black women, for example, are seven times more likely to die of breast cancer than white women, even though they are less likely to be diagnosed in the first place. This has everything to do with whose health is deemed important, whose voices are heard and taken seriously in the doctor’s office, and who has the time, space, and money for routine and extraordinary care. Having the money not only for health insurance but to cover the unreimbursable expenses from lost work, lost energy, and lost hope makes for better life chances, too. Breast cancer is a solitary experience, but how that experience goes has everything to do with larger social structures of inequity.
Here’s how my experience went. My breast cancer treatment started with a lumpectomy and removal of my sentinel lymph node—the first in the chain that leads from the breast—to see if my cancer had spread there yet. It was an outpatient surgery, uneventful, and afterward my wife and I stopped by the pharmacy to pick up my prescribed pain meds—ten oxycodone pills.
The pharmacy wouldn’t fill the prescription for some bureaucratic reason that hopes throwing up roadblocks to access will stem the rise of opioid addiction. Pain pill addiction and abuse is caused partly by the availability of the drugs, sure, but it’s also related to living in a world that pushes many of us to check out by any means necessary. And sometimes, yes, we need the pain pills for pain. It took a lot of weeping calls to a lot of after hours doctors and pharmacies for me to get the meds I needed to stay ahead of the pain, a reminder that my individual issue is part of a much larger war on drugs that doesn’t do much to change the world too many of us seek to escape.
A few weeks later I was in my oncologist’s office to hear the news that though my tumor was small, it had aggressive features, and I should probably do chemotherapy—four rounds over three months. It wasn’t presented to me as an option but as a necessary part of my care. My insurance company paid over $10,000 per round, and that was the reduced price they negotiated with Johns Hopkins. The costs are astronomical, and even if you’re lucky enough to have the costs covered, it’s incredibly expensive to be as sick as chemo makes us. My workplace took a lot of work off my plate so I could take care of myself first. I got paid my full salary for certainly not full work, a luxury few cancer patients could ever afford.
A few weeks after chemotherapy I started radiation therapy. I got a short course, two weeks shorter than most, because I’m lucky enough to live near a cancer research center whose care my insurance agreed to pay for. I had to have the same appointment time every day, and I couldn’t choose the time. They wouldn’t tell me my time slot until two days before I got started. My teaching schedule couldn’t be moved, but I couldn’t guarantee a time slot that
would allow me to keep my job, no matter how many white girl tears I cried. It’s a business, and they slot you in when they can slot you in. What if I were also managing child or elder care, or had an hourly wage job some distance from the hospital? It would be devastating, and I might even have weighed my options and skipped it altogether, increasing my risk of cancer’s return by 40%. Nothing but luck that I didn’t have to make that choice.
I lucked into a slot that worked for me, and four weeks later I was done. “Done.” My radiation oncologist announced that I was “fully treated.” I haven’t beat cancer. I’m just fully treated. And now I wait. I’ll know I’m cured when I die of something else. A day doesn’t no go by that I don’t think about cancer, that I don’t wonder if it’s back, or if it is back for my twin sister. She was diagnosed just as I finished up radiation. It has been shattering, and I am the luckiest cancer patient I know. Because not only do I have the structural supports that make extending my life more likely—my whiteness, my wealth, my good state job with benefits fought for by unions I’m not even in, the time and ease to schedule routine screenings—but I have the support of a middle class circle of friends and family who have made this brutally expensive disease affordable as they drove me to work every day, paid for my Lyft rides to treatment, and pitched in for food deliveries they knew my wife and I would need when in the thick of it.
Breast cancer hits so many of us so hard, but it lands a bit easier when we live at intersections of privilege. The Pinktober narrative of the plucky survivor who smiles through treatment and comes out grateful and ready to enter all the walkathons erases the background that got us sick in the first place, and the structural inequalities that determine which of us has a real shot at getting better. Racial, class, and gender inequalities aren’t just talking points. They are violence, they are premature death, and they are at the front of my mind this Breast Cancer Awareness Month. Breast cancer is a social, political, and economic disease, and pink just won’t cut it for me anymore.