P1: FPX

Journal of Genetic Counseling [jgc] HS070-45 February 16, 2000 14:36 Style file version Nov. 19th, 1999

Journal of Genetic Counseling, Vol. 9, No. 1, 2000

Book Review

My Mother’s Breast: Daughters Face Their Mothers’ Cancer. By LaurieTarkan. Taylor Publishing Company, Dallas, TX, 1999, 220 pp., $14.95(paperback).

Cancer risk counselors often hear patients describe their intense fear of de-veloping breast cancer. Such patients express worries such as “I’m convinced thatI’m going to get breast cancer in my mid-40s, just like my mother, just like hermother,” “I feel like a walking time bomb,” or “I’m scared to death that I’ll getbreast cancer.” Many of these patients are women with close family members thathave suffered from cancer. Daughters, in particular, are prone to developing suchfear, often believing that whatever happens to their mother’s body will happento their own. The genetic counseling process offers reassurance that such fear isnormal and that the risk of developing cancer is actually much lower than assumed.

My Mother’s Breast, by Laurie Tarkan, explores the concerns of womendealing with their mothers’ breast cancer diagnoses and their fear of developingthe disease themselves. Tarkan, who at age 12 lost her mother to a rare liver disorder,is a health writer who has published several magazine articles about breast cancer.As explained in the forward by Kathryn Kash, Ph.D., Director of PsychologicalServices at the Strang Cancer Prevention Center in New York, few support materialsexist for women with a genetic risk for breast cancer. This publication is the firstto explore the many psychological dilemmas faced by women whose mothersdeveloped this disease.

The book is divided into two parts. The first, entitled “Daughters’ Stories,”reveals through 16 case vignettes the emotional experiences of women whosemothers were diagnosed with breast cancer. The second, entitled “Taking Care ofYou,” provides current, accurate medical information on a variety of topics, in-cluding breast cancer risk assessment and prevention strategies to reduce such risk.

Many of the case vignettes in “Daughters’ Stories” discuss the actions takenby daughters while they were coping with the strain of having cancer in theirfamilies. Some of these actions included leaving their partners, putting their careersor educational goals on hold, or delaying childbearing in order to become thefamily caretaker. Some daughters made efforts to improve their relationships withtheir mothers, while others focused more on their personal well-being, becomingexceedingly anxious about their own risk of developing breast cancer. The bookindicates that a significant predictor of whether a daughter developed such anxiety

89

1059-7700/00/0200-0089$18.00/1C© 2000 National Society of Genetic Counselors, Inc.

P1: FPX

Journal of Genetic Counseling [jgc] HS070-45 February 16, 2000 14:36 Style file version Nov. 19th, 1999

90 Book Review

was whether the cancer metastasized and whether or not her mother died. If hermother died, a daughter’s grief intensified her fear of developing cancer.

Several case vignettes focus on a daughter’s perception of herself as being atextremely elevated risk for developing breast cancer. The stories of such daughtersinclude that of Kathie, who had convinced herself that she would develop breastcancer early in life. Kathie anxiously awaited a cancer diagnosis for 23 years andactually felt relieved when she was finally diagnosed with the disease. Anothervignette tells the story of Judy, who decided to have a prophylactic mastectomybecause of a high-risk perception and additional worries associated with havinglarge, cystic breasts. Jennifer’s story explains how her fear of developing cancerfear led to a depression that she felt she could not express to her mother. Otherstories describe women who underwent genetic testing to find out whether their fearof breast cancer was justified, including the story of Lauren, who chose BRCAtesting to help her decide whether to have a prophylactic mastectomy, and thestory of Julie, whose positive genetic test facilitated her recovery from an eatingdisorder. All of these true and often poignant stories shed light on how womencope with their risk, how breast cancer affects a mother-daughter relationship, andhow certain daughters may suppress their own fears in order to help their mothersbattle the disease.

Still other stories tell of women who were motivated by the occurrence ofbreast cancer to initiate therapeutic community service projects. Such projectsare described in the stories of Marcia, who traveled to the Czech Republic toteach women with breast cancer how to develop psychological self-help activities,and Caleen, whose mother, Karen, founded the Sister’s Network, a breast cancersupport organization for African-American women.

In Part 2 of the book, “Taking Care of You,” Tarkan offers advice for womenwho are concerned about their risk of developing breast cancer. Tarkan obtainedmuch of the material for this advice by interviewing genetic counselors, includ-ing Barbara Bernhardt, June Peters, Gladys Rosenthal, and Jill Stopfer. The firstchapter of “Taking Care of You,” entitled “Understanding Your Risk,” providesinformation that helps women estimate their breast cancer risk but also emphasizesthat risk levels should be determined by a genetic counselor. The chapter explainsthe process of risk assessment in a genetic counseling session and tells womenwhat to expect from such a session. Additionally, Tarkan offers some reassurance,stating that the majority of women with a family history of breast cancer discoverthrough genetic counseling that their risk of developing the disease is much lowerthan they originally thought. Tarkan emphasizes that a genetic counselor can helpwomen interpret risk figures and can assist women in dealing with the emotionsbehind their risk perception.

The second chapter in this section, “To Test or Not to Test,” outlines the factorsa reader should consider in deciding whether to have genetic testing. The chaptercovers crucial issues, such as how to make an informed choice, whether an affected

P1: FPX

Journal of Genetic Counseling [jgc] HS070-45 February 16, 2000 14:36 Style file version Nov. 19th, 1999

Book Review 91

relative should be tested first, and how to evaluate the various psychosocial risks andbenefits of genetic testing. The issues in this chapter are essential considerationsfor women contemplating genetic testing.

The third chapter in “Taking Care of You,” entitled “Reducing Your Risk,”discusses breast cancer screening and preventive factors and includes a criticalassessment of current studies on tamoxifen and prophylactic mastectomy. Theinformation provided in the chapter is consistently accurate, balanced, thorough,and up-to-date. The final chapter, “Coping,” describes strategies women can use tocope with the psychological burdens of having an ill relative or feeling that one’srisk of developing breast cancer is high. The book closes with a list of resources,which includes support organizations, sources for obtaining screening information,various genetics contacts, and comprehensive cancer centers.

Overall, women who are worried about their genetic risk of breast cancer orwho are considering genetic testing will findMy Mother’s Breastan accessible,interesting, and helpful resource. Additionally, genetic counselors, health coun-selors, and psychologists are likely to find the case vignettes enjoyable readingand may wish to show or lend the book to their patients. Since Tarkan’s book isfocused directly on the risk factors, fears, and experiences that patients face, itsuse can enhance the genetic counseling process and serve as a valuable source ofadditional information and support.

Julie CulverFred Hutchinson Cancer Research Center1100 Fairview Ave N., MP 702PO Box 19024Seattle, WA 98109-1024