Health

By LAUREN GROVER
Staff Writer

Nothing about Margo Adams says cancer. She seems to avoid using the word “survivor.” The 59-year-old rarely stays on topic when discussing the disease she’s taking every step to prevent.

Her mother died at 42 of ovarian cancer, 25 years before gene testing was available. Margo’s proactive in a way her mom couldn’t be. And, she said, there are important people to live for.

“My kids,” she said. “Without a spouse, I have to be strong for them. You don’t think about what you have to go through – you might have bad days, oh well.”

On Feb. 8, surgeons performed a double mastectomy on Margo at M. D. Anderson Cancer Center in Houston. But it wasn’t because she had cancer.

“It’s my choice,” she said. “No doctor could actually recommend it, but they also didn’t say I shouldn’t do it.”

Due to an altered gene, Margo had a 65 percent chance of breast cancer, despite an elective hysterectomy in 1989 and successful treatment of one bout of breast cancer in 2003.

Dr. Bob Fender, a general surgeon with the East Texas Medical Center Breast Cancer Center in Tyler, said recommending bilateral mastectomies for women who suffer from altered BCRA genes isn’t uncommon.

On surgery day, among the families gathered in the recovery floor were Margo’s kids — Brian, 29, Susan, 24, and twins Kathryn and William, 20 — who, while waiting, befriended other patients, in particular a younger woman who was alone.

“She was by herself, and had cancer, and it was really sad that no one was with her,” Susan said. “So we were acting like her family.”

Margo was wheeled out of surgery nearly 11 hours after it had begun. Her dazed appearance was hard for her children to bear.

“We all had tears in our eyes, ’cause she didn’t look good at all,” Susan said. “She was extremely sore, and on a lot of drugs, but the doctors said everything went well, so we felt good about that.”

It didn’t take long for Margo’s determination to kick in. By noon the following day she stood up and got into a wheelchair. She slept a lot, but with incisions circling her torso, it was a stiff endeavor.

“She kept saying, I feel so tight, it’s so tight,” said best friend Debbie Roost. “I was telling her, it’s like your back was tucked.”

Eight drainage tubes were cleaned each day by nurses.

“I could lift my arms; I was walking in the halls in a couple days,” Margo said. “I did have one grumpy day, but a friend rubbed my feet.”

A gush of relief came when doctors told her that a final biopsy of her once-cancerous breast tissue was benign.

“It’s all clear, the biopsy is all normal,” she said. “It’s so nice.”

Recovery was slow and steady — walking, arm movement, resting and aches. Back in Tyler, it evolved into driving and short errands. Still, Margo wanted it to go faster.

“I was just surprised how long I didn’t feel good,” she said Tuesday. “I wanted to be out and moving. Time ain’t my thing; I wasn’t gifted with patience.”

But any other 59-year-old would be thrilled to have such a recovery, Debbie said.

“For a regular person you’d think she’s 100 percent, but for those of us who know her, she’s not,” Debbie said a month after surgery. “But truth is, she’s doing remarkably.”

Mastectomy might be the most comprehensive form of breast cancer prevention, but it’s not foolproof. According to a 2004 study, of the breast cancer patients at M. D. Anderson who opted for preventative mastectomies, about 5 percent still suffered from new breast cancers.

“It does not convey a 100 percent chance of eliminating the risk, but it’s as close to anything we currently enjoy,” Dr. Fender said.

Margo said she knew this going in. But her choice was still the most proactive step in her reach.

“There could still be some cells floating around there, but I could walk outside and get hit by a car, you know?” she laughed. “You do the best you can.”

Gene testing, and the desire to know what fate your body’s fingerprint might reveal, is an empowering tool, Margo said.

“People think I’m brave,” she said. “I think a lot of people wonder why I even want to know.”

Doctors are merely toe-deep in knowledge of how genetics could lead to treatment, prevention and even predevelopment eradication, Dr. Fender said.

“It’s a Star Wars kind of concept, that medications or substances could be directed to prevent those (altered) genes from working their little magic function,” he said.

Like mammograms, genetic testing could someday be routine, offered at every hospital, honored with a National Gene Test Month or advertised with discounts, he said.

And for good reason. Dr. Fender suspects breast cancer’s causes are genetic-related with more frequency that doctors know, he said. Only 5 percent are identified with gene abnormalities now.

“It’s because we haven’t identified the genes yet,” he said. “And it’s going to be a lot more than five percent.”

Still, about 1 in 10 women who see Dr. Fender with breast cancer receive a 21-gene test, a tool that tells doctors whether a particular cancer is high- or low-risk.

The 5-year-old test is revolutionary: In some patients it can mean less chemotherapy for a tumor that appears dangerous; in others it could mean aggressive therapy for an unthreatening smallish lump.

Margo said she hopes women take advantage of all technological advances at their fingertips, much of it available at Tyler hospitals.

“There’s not a reason to be afraid,” she said. “I hope other people realize how rare these genes are, but if you have them, you need to be proactive to take care of yourself.”

By the first week of May, Margo was released by her doctor to do any sort of exercise she wants. Two days later she returned to Pilates. She’s anticipating the Komen race on Saturday.

A hot water leak that flooded her house kept her quite occupied during recovery, she said.

But a leak might be a refreshing worry compared to cancer. The disease is no longer an anxiety, she said.

“I know there’s nothing more I can do,” she said. “If it happens, it does. But I did all I could do. I want to be healthy — and live to be old, with my mind, only with my mind.”

Margo Adams is alone with her thoughts as she waits for her surgury, a double mastectomy and reconstruction of her breasts with back muscles, at M.D. Anderson in Houston on February 8.
((Staff Photo By Herb Nygren Jr.))