Nancy Matthess figured the odds were against her. Out of two generations on her mother's side of the family, seven of the nine women developed breast cancer. The eighth girl died as a child. The last one was her.
The Hilton Head Island resident never had the disease, but the thought of it started to haunt her. She felt like it was waiting for her. It was only a matter of time before she found a lump, before the months of chemotherapy, before the frailty, the sickness ...
So, she decided to do something about it.
She decided to take her own breasts before the cancer could.
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Four years ago, Matthess decided to undergo a pre-emptive double mastectomy. She doesn't feel haunted anymore. That phantom has been exorcised.
"I used to think about it every day," she said. "I don't do that anymore."
That said, the decision to undergo a major surgery isn't a light one. With any surgery, there's potential complications. It's a decision that Matthess pondered, fretted and stewed over for weeks before finally making a decision. Although a tiny risk still exists that she could develop breast cancer, she sees her golden years through a lens that isn't clouded by cancer.
"It's probably the hardest decision I had to make in my life," Matthess, 64, said. "But it's a decision I don't regret."
Cancer had always been part of a backdrop in her family's life. She was her mother's only daughter, but the female cousins in her generation got it. Her mother got it. Her mother's sisters got it. Some died; some survived. The whole family lived it. Once she entered her 40s, she started to think of herself. How much longer can I go on?
Then her daughter-in-law got it. She stayed up New Year's Eve four years ago and shaved her daughter-in-law's head, parting her with the hair that had been thinned by treatments.
"It just hit me," she said. "I wanted to go under my terms. I had to face it. I felt like I was a ticking time bomb."
She consulted Dr. Richard Hussong of Surgical Specialists on Hilton Head. Matthess was a nurse by profession so she knew the potential complications that could arise from any major surgery as the one she was considering. Considering her family history and the fact that some relatives developed the disease young, Hussong and a medical geneticist confirmed that she was at an increased risk.
However, Matthess did not undergo testing to detect potential mutations in the so-called BRCA, or breast cancer susceptibility genes. Mutations in the genes can mean an increased risk of developing cancer. However, a positive test doesn't guarantee the patient will get cancer. And a negative test doesn't guarantee a person won't get it. Matthess found that out first-hand when her daughter-in-law tested negative for the mutation but got the disease anyway.
A double mastectomy can greatly lower the risk of getting breast cancer but not entirely. Hussong estimates that a mastectomy can remove about 98 percent of tissue where cancer could develop. However, because breast tissue can be found along the chest wall, sometimes as far as the arm pit or collarbone, a mastectomy can't get rid of it all.
"It's not a cure-all," Hussong said. "It's not a decision to be taken lightly."
A doctor can advise. The decision rested with Matthess. Within a week of applying, her insurance company told her it approved her surgery.
"It became a reality then," she said. "I was having second thoughts up until I went into the hospital room. I was nervous because you don't know how it's going to end up. What if I destroy everything, and I didn't have to?"
She underwent a two-part surgery; first removing the tissue and then filling the breasts with a silicone implant three months later.
So far, no complications have arisen. She lives comfortably in retirement now, happily willing to talk and counsel anyone who finds themselves in a similar situation to hers.
Cancer is part of the story of her family, but, hopefully, it won't be part of her own story.
"I'll die some day, but it won't be because of radiation and chemo and all that," she said.