McNamara's instincts turned out to be better than her surgeon's. Ten years after her mastectomy, the National Cancer Institute issued an emergency clinical alert to physicians, recommending that chemotherapy follow soon after surgery for all but the least threatening breast-cancer cases. Clinical trials had demonstrated convincingly that chemotherapy administered right after cancer surgery - called adjuvant chemotherapy - could help prevent the disease from returning and could thus improve the patient's chances of survival. Nowadays, adjuvant therapy is the standard of care for most breast-cancer patients.

McNamara had good reason to be so cautious. Breast cancer in a thirty-two-year-old woman is extremely rare and especially frightening. For reasons no one clearly understands, when the disease occurs so early in life, it tends to grow aggressively. In the United States, the chance that a thirty-two-year-old woman will be diagnosed with breast cancer is less than one in four thousand. Only 6 percent of breast cancers in the United States strike women under the age of forty. The odds only grow worse as women age; the chance that an eighty-five-year-old woman will have developed breast cancer over the course of her lifetime is one in eight. In McNamara's case, the only relatively good news was that tests showed that the cancer had not yet spread to her lymph nodes, meaning that the chances of a recurrence were less than they would otherwise have been.

Though half of all women with breast cancer never suffer a recurrence after the initial treatment, they are still sentenced to a life of uncertainty, never sure if they will join the half that does have a recurrence; and when the cancer reappears, it is always deadlier than it was the first time around. For Anne and Jeff, breast cancer brought a particularly severe disappointment: Luke would have to be their only child. Female hormones can fuel the growth of breast-cancer cells, so a pregnancy, with its massive hormone surges, can greatly accelerate a recurrence, especially if diseased cells have managed to escape the surgeon's knife. Nowadays doctors will allow some breast-cancer survivors to risk a pregnancy, but when Anne was diagnosed it was out of the question. "That was a blow," says Anne. "We had waited for seven years after we got married to have Luke." With her hands folded calmly in her lap, she explains, "I knew it would be silly to have another infant if there was a chance I wouldn't be around to raise it. I didn't want to leave my husband with a new baby, and I didn't want to leave a new baby without a mother."

With her knowledge from the cancer lab, Anne could interpret the facts. Jeff had no similar understanding to temper his fear. He only knew that Anne might not always be there, and even twenty years later he is visibly upset at the thought, and he speaks freely about his confusion, fear, and frustration. His take-charge attitude had worked for him during his four years in the Air Force, and it had brought him success as a consultant to high-tech companies. But here was a problem that he couldn't solve. "If it had been a hole in the roof, I could have fixed it. But there wasn't anything I could do but be around to keep our life together. I just couldn't do much else."

"I mean, I was upset," he continues. "Not traumatized, but certainly upset. But Annie puts on a very good face, and is not an outwardly worrying type. And I think that has a lot to do with it." He pauses to laugh. "I mean, she's got a steel backbone."

McNamara left the hospital a week after her mastectomy, but she still faced reconstructive surgery. Her surgeon had recommended that she not have it immediately, so she waited nearly a year. "[He] said, 'Don't do it right at first because even months afterward, whatever reconstruction you have done, it's never going to look like a real breast. It's just not the same.' " She smiles wryly when she remembers the rest of their conversation: "He said, 'If you wait a while, then when you have it, you will be so glad to have a breast again that you won't be so picky that it doesn't really look like the other one.' " She pauses while the listener savors the full arrogance of that advice. McNamara is loath to launch an attack on her doctor for his clumsy statement. She simply dismisses his comment as "a male point of view."

Waiting for reconstruction was the hard part. "I didn't feel feminine. I didn't want to have to worry with the stupid prosthesis; I wanted to be able to go swimming and wear a bathing suit and not have to worry about the dumb thing."

In the meantime, she was determined to return to her life. A computer programmer since just after her marriage, she had taken a leave of absence to care for Luke full-time. She gave whatever time she had left over to her gardening and community work. She exercised as the surgeon prescribed and recovered full use of her left arm, which had been somewhat incapacitated by the surgery. "I put cancer out of my mind," she says.

McNamara is a modest woman who is reluctant to talk about herself. She maintains a quiet reserve and regards her misfortune as her own business, never telling people about treatment except for some very good friends. She says that many people, not those to whom she felt close, just don't know what to say. "It scares them. Yes, it terrifies people, especially breast cancer, and other women particularly. And because they don't know what to say, they don't treat you like a normal person. I don't want to talk about it with casual friends. I want them to invite me over and not have the topic of conversation be illness. Oh, how are you, isn't it awful? How do you feel? You look so pale." But others did not share her sense of discretion.

"Word got out," she says. Friends were stunned, particularly because she was so young. When she ran errands in downtown Branford, Connecticut, mere acquaintances would race across the street to say, "I just heard the most unbelievable thing. It can't be true!" The attention and sometimes tactless concern embarrassed her. "It affected me so," she says softly. "Once people know you have cancer, that's all they remember about you. They don't know what to say, and they avoid the situation. They don't mean to, but they write you off." She stops for a moment and then adds, "I just wanted to be treated like a normal person with a future."

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© 1998 Robert Bazell.

Tags: Breast Cancer

About the Author

Robert Bazell is the chief science correspondent for NBC News. His reports, which appear on the NBC Nightly News, Today, and Dateline NBC, have won every major award in broadcasting. He has written for many publications, including The New Republic, The New York Times, and The New York Times Magazine. He lives in New York with his wife, Margot, and daughter, Stephanie. More