Personal Views: Amazons go shopping
Authors: Mary E Black
Journal: BMJ (2006)

We are a family of one breasted women; some of us have lost two. Mine are in pretty good shape; they have been widely admired in the past and have almost four feeding years racked up on their milometer (lactometer?). I have sensibly and unemotionally accepted that my breasts may be time limited parts of my body. Sometimes I wonder which one might get lopped off first—the ever lumpy right one, or the left one, which was the children's favourite. “Because you were close to my heart” I used to tell my two children when they asked me why as babies they liked feeding from my left breast the most.

We are a family of matter of fact, over-achieving, well endowed women with careers and medals and babies. I self check with my patients, friends, and family. I hold cancer in awe but not in terror; if you get cancer, you deal with it and move on.


My mother takes an Amazonian view that not many people look at your chest when you are 80


My mother, a retired anaesthetist, had a mastectomy three years ago at the age of 77. Her surgery went well, we reviewed the lymph node staging (no spread), the histology (slow growing squamous cell, nothing too scary), the tumour markers (oestrogen receptor positive), and her various treatment options (tamoxifen, which she has now discontinued). We went shopping for prostheses, weighing options carefully and literally—a too-heavy prosthesis can cause shoulder ache. When I finally persuaded her to go swimming I knew that both the physical and mental wounds were healing well.

The children got involved too and watched my mother's scar as it went from raw with a drainage bag to healed and pink. They poked the prostheses and absorbed the family mantra: it is not a catastrophe to remove a breast.

Then the hospital sent me a leaflet. Given our family history, genetic screening was strongly recommended. Genetic counselling and blood testing for BRCA1 or BRCA2 genetic mutations screening add a new set of possibilities—risk reduction (which I should do anyway), increased surveillance, chemo-prevention, and preemptive surgery—into my carefully balanced and accepted beliefs. Genetic screening could tell me about my 11 year old daughter's chances, and even her chances of passing it on to her daughters in turn. But how much did I really want to know about my risk and the risk facing my daughter?

“Learn from the Amazons,” said my mother. “My breast did a good job and although I miss it I do not need it now.”

We looked up Amazons on the internet: mostly myth with some facts. From an early age Amazons were trained in the arts of war and the right breast of the young Amazon girl was cauterised by her mother so that she would be deft with the various weapons of war. Males were of no use other than for mating purposes and as slaves; the limbs of the men were amputated so that they could not rebel and escape; male babies were either given away at birth to neighbouring tribes or killed. We decided that we liked daddy and her brother (aged 6) and so decided to keep them for the time being. But we did agree on this: Amazons discard their breasts if necessary.

Then I realised what was bothering me: I had an unstated belief that young women in our family would not get breast cancer. Genetic counselling could confront that. What made me finally book my appointment? A mixture of my medical training, a rigorous review of the facts, acceptance that new information might bring a difficult choice, and the realisation that I was behaving like an ostrich. My beliefs made no sense. I do want to know as much of the truth as I can find out, and my daughter has the right to know this too.

I have now completed the clinic's family history on all the one and no-breasted women in our family tree—my grandmother, my two aunts, my mother, and my first and second cousins—and on the men too. My daughter will come with me to London for the day. After the hospital appointment we will have lunch at a Japanese restaurant where the dishes go round on a little railway track and then we will go clothes shopping. I will buy something low cut and glamorous. My mother sends her best wishes. Over the past year she has shed her prosthesis and goes around a bit lopsided. She takes an Amazonian view that not many people look at your chest when you are 80 and that no one at all will look at your chest if you are dead.

My daughter also takes a pragmatic view of our planned day out. She believes that modern day Amazons should just get on with all the hospital stuff and then concentrate on shopping.