My Chance for Life

Miralda's eyes are the soft green of sea glass. Expressive, lively, they light up when she smiles (which she does often) and dance playfully when she laughs.

Then suddenly, unexpectedly, they're sparkling with tears. It's the surgery, she says shyly. She's afraid of the surgery. Of the hospital, and of the pain afterwards. She blinks, gently shakes her head, and the tears are gone.

And that's the only time during our two-hour meeting that she shows fear which, in a strange way, is a relief because I'm so appalled by what she has to go through, that her fear is all I can connect with.

In January, scientists of Genetics confirmed what Miralda had suspected for years - that she carries the gene for breast cancer.

Her mother had breast cancer at the age of 32, and died at 50 when the cancer ate into her bones. Her grandmother Aletta was 62 when they discovered cancer in one breast. She lived for 14 years before it spread to her marrow. Aunt Sylvia's cancer spread from her colon to her liver; and 10 years ago aunt Elain had a double (bilateral) mastectomy.

‘It was when my mother died that doctors suggested I go for genetic testing,' says Miralda ‘and I wanted to do it, but with the grief and the trauma that followed I never got around to it.'

A year later it was suggested again, and this time she made contact with the clinic. They took a full family history and against that there was clearly something hereditary that warranted further investigation.

Geneticists needed a blood sample from a close relative who had survived breast cancer, and in Miralda's case that was her aunt, Elain. Most families at risk have a unique gene mutation which carries from generation to generation. The only way to isolate the particular mutation is to test a living relative.

Hereditary breast cancer occurs in about 10% of breast cancers, and in Miralda's case there was an 80% chance she'd develop it at some point in her life.

She had three options:

to closely monitor her breasts for changes or signs of cancer through regular mammograms, ultrasound sonar and Magnet; Resonance Imaging (MRI);

to go the chemo prevention route using drugs like tamoxifen or raloxifene. Studies indicate that these drugs can reduce the risk by up to 60%, but they do carry side effects;

or to have both breasts removed, which doctors term ‘risk-reducing mastectomy'.

Miralda chose the third option, generally (and obviously) the least popular among young women.

‘I was told that because I had the gene, I had an 80% chance of triggering breast cancer which, obviously, I wanted to prevent,' Miralda says. What she didn't initially realize was that losing her breast tissue meant losing her nipples also. ‘That was the real shock. Up until then I'd thought it would a bit like breast reduction surgery; but when I heard I'd have to lose my nipples as well, I wasn't so sure anymore.'

‘I was very undecided,' says Miralda, but her family history, and knowledge that 25% of all women who get breast cancer develop it in the nipple, eventually persuaded her. ‘My dad was very supportive - he'd seen what my mother went through - and my brother said that at the end of the day we all grow old... at least this way I won't be sick, I'll have life.'

It was her aunt Elain who was to be her biggest inspiration. She's so positive, she's successful and stunning. She told me life isn't the end after you lose your breasts. Her trick is to wear beautiful lingerie. She says it makes her feel fantastic.' Miralda is in a stable, long-term relationship. It was essential that she involve her boyfriend in her decision. Miralda's doctors talked to him about the procedure, showing him pictures of the kind of breast re-construction she would have after surgery.

Other friends were not as encouraging. ‘They were horrified. They couldn't understand why I wanted my breasts removed, why I didn't just have regular checkups,' she says. Miralda is a vibrant, sporty young woman with a lovely figure and good-sized breasts. I understand her friends' dismay.

‘They didn't understand that I'm fighting for my life here. There were days when I felt the whole world was against me,' she says. ‘Watching my mother suffer was a big part of my decision. Yes, it was a difficult thing to do. My life has been turned upside down. Choosing a mastectomy is like choosing amputation when you are healthy. But I honestly believe I am doing everything I possibly can to prevent getting breast cancer,' she says, her green eyes blazing with passionate conviction. ‘This is my second chance.'

For a moment she's silent, gazing into her coffee. Then she says: ‘Can you imagine what it would be like if I'd chosen to go the route of regular monitoring? Every time I went for the next examination I'd be wondering whether the test was positive this time. I couldn't stand living with that kind of fear every day of my life.'

Having just driven dry-mouthed from my doctor's consulting room to a clinic for my first mammogram I have an inkling of that fear. The possibility that cancer will show up is paralyzing.

Our interview over; she gets up to leave. Her slim body in a figure-hugging polo-neck catches the eye of a young man at the next table. I have no doubt that this incredibly brave, beautiful young woman will be catching many more flirtatious looks in the future.