Go forth and procreate or else its off with your breasts.

The womanly threads that bind cancer and pregnancy

Hola Global Jigsaw,

If happiness and grief be opposites, as life and death are presumed to be, surely one would be forgiven for thinking that pregnancy and cancer are conditions so far apart as to not warrant place in the same thought.

And yet, when I was diagnosed with breast cancer, much felt reminiscent of when I was pregnant- the two predicaments bound together in their womanliness, their concerns with nipples and hormones, and the manner in which they involved an alien presence within the body of the host.

In her seminal tract, Illness as Metaphor, Susan Sontag quotes the 18^th century German polymath Novalis as defining cancers thus, “full-fledged parasites - they grow, are engendered, have their structure, secrete, eat.” She adds what St. Jerome had to say about the disease, “The one there with his swollen belly is pregnant with his own death.” (“Alius tumenti aqualiculo mortem parturit.”) The metaphor of cancer as fetus has pedigree.

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The most onerous part of my cancer journey was getting an accurate diagnosis. This involved a six week-long conveyor belt of doctor’s appointments, scans, blood tests and second opinions, the likes of which I had not known since my pregnancies. I found it strange that every time a doctor or technician took down my medical history, among the first questions they asked was how old I was when I began menstruating and the age at which I had my first child. (It provoked some consternation when I thought I was being asked the age of my first child, rather than the age I gave birth to him, and I replied, “13.” My Spanish could do with some improvement.)

I learned that getting your period before the age of 12 and having your first child after the age of 30, are both risk factors in developing breast cancer. The majority of breast tumors, mine included, are hormone positive. These breast cancer cells have receptors, a type of protein, that attach to estrogen and progesterone- the chief pregnancy hormones.

The longer a woman menstruates, the higher her lifetime exposure to these hormones and the greater the likelihood of hormonophile cancer cells developing to grab on to them. Conversely, pregnancy and breastfeeding, which both reduce the lifetime number of a woman’s periods, and thus her cumulative vulnerability to ovarian hormones are associated with a decrease in breast cancer risk.

In short, the less time you spend being pregnant and breastfeeding in your fertile years, the higher your likelihood of developing breast cancer. For women it’s biological sabotage; the cosmic curse of a patriarchal God. “Go forth and procreate or else its off with your breasts.”

(Fun fact: this explains why breast cancer has long been known as the “nun’s disease.” It was named thus by an Italian physician,  Bernadino Ramazzini, who noted in 1713 that nuns suffered from extremely high rates of breast cancer. Some scientists now recommend that the Catholic church freely distribute contraceptive pills to its nuns, in order to suppress their womanly hormones and thereby reduce their “greatly increased risk” of developing female-specific tumours.

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The other thread that tied my experience of pregnancy and cancer was the guilt. It is confounding how much subtle blame a pregnant woman, as much as one diagnosed with breast cancer, is subject to, because of what she has been eating.

You ate too much sugar, you had a smoke, you didn’t manage stress, you didn’t exercise enough or was it too much? No matter: it’s all your fault.

Reading about what might have “caused” my cancer was laughably like the reading I did when pregnant: full of warnings of dangers lurking in the microwave.

A teratogen is a substance that is potentially harmful to a developing embryo or fetus. And my word, these pesky things were everywhere. Hot tubs, ibuprofen, microwaves, cling foil, anti-perspirants, hair dyes and even cats were all skulking enemies of the pregnant woman. And there is “research” to show that each of these (except the cats) may also be responsible for breast cancer.

Everyone had an opinion on what I should eat when I was pregnant: no cheese, no sushi, no cold foods, or was it hot ones? No matter: my diet was everyone’s business. So too, have many people taken it upon themselves to send me lists of alkaline foods and cancer-starving ones; no-sugar diets and all manner of juices I can apparently take to replace chemotherapy. My diet is every well-intentioned person’s business once again.

And then, there is the woman’s attitude and the question of whether or not it is positive enough to ensure a smooth pregnancy, a calm baby, or remission from cancer. The implication, even if unintended, is that if someone has a difficult pregnancy, colicky baby or breast cancer metastasis, it’s her fault for having failed to radiate positivity, as her body is being split open, mutilated, consumed and endangered.

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But it was really when suffering the side effects of chemotherapy that my pregnancies felt closest. These were the two periods in my life that the toilet and I spent in an intimate embrace. Chemo brought on nausea, muscle aches, brittle nails, fatigue, the narrowing of life to a focus on the physical. But these were old friends, or foes, or acquaintances – it is difficult to know quite how to describe them. They’d been by a couple of times before.

I already knew, from my pregnancies, the process by which one becomes a stranger to oneself. How the dressing table mirror takes on the avatar of its reflection-distorting fun fair cousins. It is you who looks in, but something other that looks back out.

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The great difference between pregnancy and cancer, is that one is synonymous with life and the other with death. Yet for most of human history, pregnancies have resulted in high mortality rates, with neither the lives of mothers nor those of babies being assured. Can we imagine a similar evolution for cancer? A time when it is no longer conjoined with mortality. Already doctors have begun to dare to use the word “cure” for early-stage breast cancer. Dare we hope?

But, someone may protest, pregnancy has a happy ending and cancer, even if not fatal, is an unhappy outcome. To this, I would say that although having children is a profound joy, it is that precisely because birthing and parenting are difficult. Growth and depth of experience are earned through overcoming challenges, not through what is easy.

The greatest gift of early stage cancer is gratitude and appreciation of the little things: being able to enjoy a cup of coffee (without throwing up!), going for a walk (without feeling exhausted), having a hot shower (without needing to protect a wound). Both giving birth and having cancer have helped me to put things in perspective. There is one great truth, cliché though it may be: life is short. Sort out your priorities and focus on them.  

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This is the 5th in a series of pieces I’ve done on and around cancer since my diagnosis. Links to the others are below. Feel free to share and thank you, as always, for your attention and support.

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Until soon,

xo

Pallavi