Tomorrow, May 31, 2022 I’ll be having surgery to remove my fallopian tubes. This surgery is the first in a series of pelvic surgeries to prevent ovarian cancer due to my BRCA1 gene mutation. BRCA1 is a gene that causes an increased risk of breast cancer (up to 80%) and increased risk of ovarian cancer (up to 60%). I found out I had the BRCA1 gene mutation when it first manifested as breast cancer when I was 28 years old.

At that time, everyone was focused on my breasts (which I surgically removed in 2013 in order to prevent any further breast cancer). I remember the doctors telling me not to worry about the ovarian cancer part, as the risk only starts to rise around age 40 (newer studies indicate that 35 is the magic number). 

But now time has run out. I can’t believe I’m here. I can’t believe all this time has passed. I’m 38 years old, already 3 years past the new recommended age for this prophylactic surgery, and it’s time.

Unfortunately, there are no good screening tools for ovarian cancer, which has a mortality rate of 50%, and therefore the recommended treatment for women with a BRCA1 mutation is to surgically remove the ovaries, fallopian tubes and usually the uterus to prevent the cancer from ever starting. 

Overall, I feel good about this move. If I weigh the costs and benefits, doing this salpingectomy is a no-brainer. My risk of ovarian cancer is beginning to rise, going up to 3% at age 40. And the risk of dying from ovarian cancer is about 50%! So I am approaching a 1.5% risk of dying of ovarian cancer. While still small, it’s much more than the average person and I have a lot to live for! I have a baby, a family, a growing soul-business. I have so much left to learn, to do, to see, to experience.

Just to be clear, this surgery will not reduce my risk to zero. In fact, the amount of risk reduction for just a salpingectomy as opposed to an oopherectomy and hysterectomy (removing the ovaries and the uterus) is still being studied. But whereas the costs of an oopherectomy and hysterectomy are extremely high (early menopause and the inability to carry a pregnancy), removing the tubes just means that we won’t be able to get pregnant naturally. 

It’s still a loss. One that I have sort of already experienced, having tried for months to conceive and resorting to IVF to have my first child. I now know that the chances of me conceiving naturally are probably less than 1%. I have one blocked tube, a thin uterine lining, and there were some male factors as well. But this - this surgery - it is so final. 

In some ways it is good. Now I won’t have to have that anxiety, pressure and disappointment every month when I get my period. But it’s also sad. We won’t ever have a carefree pregnancy. No jokes about getting “knocked up.” None of that optimism when you realize your period is late and the shock and joy when the second line of that test turns pink.

And it also opens up a door I wasn’t totally ready to open yet. I’m moving out of the young “previvor” category where I had time and into the space where the only currently preventative method available for a deadly cancer is the barbaric removal of body parts. 

Having my ovaries removed (as opposed to just the tubes) absolutely terrifies me. I may be ineligible for hormone replacement therapy because I had breast cancer in the past, and therefore I will have to go through menopause about 10 years early. This could put me at a higher risk for osteoporosis, alzheimers, and other diseases, not to mention hot flashes, weight gain, poor sleep, and the other fun side effects of losing your primary source of estrogen.

I’m buying myself time with this salpingectomy. But how long will I ease my anxiety?  Another 6 months? A year? 2 years? My body is screaming no! I’m not ready for this! Time is going too fast. It’s not fair.

No, my friends, it is not fair. Life is not fair. Cancer is not fair. 

I have to remind myself to take a deep breath and stay in the present moment, where everything is ok. I have to remember that my genetic code is out of my control, and while some things I do or don’t do may help prevent ovarian cancer (epigenetics), with the statistics on BRCA that just isn’t something I want to risk. What is within my control is educating myself about the latest research and options (like this salpingectomy). What is in my control is taking care of my health to the best of my ability. What is in my control is making each day matter, and making this loss matter. What is in my control is finding and supporting other women going through this painful journey. 

And I have to remind myself that I’m doing this for me. I’m doing this for my family. I’m doing this for my daughter. So that I can dance with her at her wedding one day. So that I can live with more peace of mind. Those are some huge benefits. And that is exactly what I’m going to be thinking about as the anesthesiologist counts me down to sleep on May 31: 10…9…8…7…