A recent Facebook message from a total stranger, one of dozens and dozens Jessica Queller has received since she went public this year with an agonizingly personal medical decision, shared a familiar story.
The stranger, a woman in her mid-30s, was a cancer survivor, unmarried, with no immediate matrimonial prospects. She wanted to have children.
Now 39, Queller has never had cancer. But she probably would have. Genetic testing five years ago indicated that she had a mutation in the BRCA1 gene, a marker that would give her a nearly 90 percent chance of developing breast cancer and a nearly 50 percent chance of ovarian cancer.
At 34, a successful television script writer in Los Angeles, she decided to undergo a prophylactic double mastectomy, drastically reducing her chances of developing cancer, a choice she describes in “Pretty Is What Changes” (Spiegel & Grau), a memoir dedicated to her mother, who died of ovarian cancer in 2003 at 58.
In the book, her first, Queller tells about her surgery, her recovery, her emotional state and her confidence that she made the right choice.
“This is what my mother would want me to do,” Queller says in a telephone interview. “My mother’s death would not be in vain if I could use her story to help another person.” She means another young woman like herself who could use such genetic testing — not fully available when Queller’s mother became sick — to test for the mutation, which is especially prevalent among Ashkenazic women, and to weigh the choice of having her still-healthy breasts removed.
Queller says her mother, a beauty, would have chosen the surgery. “She would be alive today.”
In “Pretty Is What Changes,” based on a lyric from Stephen Sondheim’s “Sunday in the Park with George,” Queller’s life is literally an open book. She tells about her filled-but-often-unfulfilling social life. “It’s been a little bit difficult to find a husband while I was trying to get pregnant.” She tells how she decided, at a friend’s urging, to take the genetic test, then, when she tested positive, to have the mastectomy. “My mother would insist I have the surgery.” She tells how she, well-endowed, decided to downsize as part of reconstructive surgery. “I feel very comfortable in my new body, I feel very much at home.” She tells how she would have a child, AND? then have her ovaries removed, if she were not married by 40. “My [biological] window is closing. This is my last chance.”
Queller, still single, is four months pregnant, thanks to the intrauterine insemination procedure and an anonymous sperm donor.
Four months after she delivers — her child will be a daughter — she plans to undergo the ovarian surgery, ending her ability to have further children through natural means but increasing her odds of having a normal lifespan.
“My health is excellent,” she says.
Which is why she has chosen the elective, but potentially life-saving operations.
“Hard decision? Deciding whether to go to law school or take one’s chances as a writer is a hard decision,” she writes. “Deciding whether to have amniocentesis when you’re pregnant is a hard decision. Deciding to cut off your breasts when you don’t have cancer and possibly never will? To me, that was insanity.”
But not having surgery that would reduce by 90 percent her chances of eventually getting breast cancer would be more insane, Queller finally reasoned. She had begun annual mammograms at 30, has continued frequent MRI examinations, and has come out cancer-free each time. “I have a peace of mind that I never had a cancer cell in my body.”
The estimates of the number of women in the United States with a BRCA1 or BRCA2 mutation range from 1 in 300 to 1 in 800. Basal-like breast cancer tumors, whether caused by BRCA1 mutations or by non-hereditary factors, are considered especially aggressive, more likely to be fatal than other types of cancer, and more resistant to standard breast cancer treatments.
Researchers at the M.D. Anderson Cancer Center in Houston reported in a recent edition of the Cancer journal that women who carry a BRCA mutation are more likely than other high-risk women to favor a prophylactic mastectomy. According to a University of Minnesota study, the percentage of women with cancer in one breast who opted for a double mastectomy doubled from 4.2 in 1998 to 11 in 2003.
Queller is a walking statistic.
A native of Greenwich Village who hosts Passover seders in her L.A. apartment and joins her family for High Holy Days services “when I’m able to fly to New York,” she will soon be a New Yorker again.
Queller recently quit her job as a writer for the CW Network’s “Gossip Girl” (she’s also written for “Gilmore Girls,” “Felicity” and “One Tree Hill,” and will move back here to raise her daughter and be near her family. She’s begun looking for freelance TV writing assignments, which will allow her to work at home.
Today, as a “poster girl for breast cancer” — actually, for breast cancer prevention – she is attracting the type of fame she sought as an aspiring actress. “I wanted to win a Tony Award.” Today, she gives frequent speeches to Jewish women’s groups. “They’re very eager to get information to help themselves and their daughters.” Today she answers the possibly life-and-death, certainly self-image-altering questions posed by other young women. “I don’t believe in proselytizing,” but she shares her belief in the value of genetic testing and pre-emptive surgery. Today, she is a voice of experience. “I want to serve as an example for the women who have the inclination to take their health into their own hands.”
Today, she has no doubt that she made the right medical decisions. If she hadn’t had the mastectomy, “I was assured of getting the cancer.”
Though she has no doubt about her decision to write about her private struggles, she says, “It is inconvenient to be so public.”
“Pretty Is What Changes” — whose cover features a photograph of the author, a knockout by any standard — grew out of an op-ed piece she wrote for The New York Times in 2005.
Her agent suggested she write a book. “I never thought about writing a book,” she says. “I’m a drama writer.”
Accepting her agent’s decisions, she began reading over the diaries she had written when her mother, who earlier had survived a bout of breast cancer, was sick.
“It was the hardest thing I’ve ever done,” she says. “I cried and cried reading every word she said. I sobbed every day for the first three months. It was very painful.”
Queller was “traumatized” by her mother’s vitality-draining battle against ovarian cancer. “I remain so. Life is never the same.”
She wrote the book, Queller says, partly to keep her mother’s memory alive for her, partly to establish in the cancer community a legacy of helping. “I had a very strong feeling that this is what my mother would want me to do.”
The book’s message: “Don’t be afraid to get information.” Information about possible health risks in your genes.
Would she advise a mastectomy for a young woman who has not developed breast cancer? “It’s not as bad as cancer,” she says, adding, “I’m not saying it’s a walk in the park.”
In her book, Queller describes how, post-surgery, “my chest felt like I’d been run over by a truck. I gasped from the pain.” Four days after the surgery, she went home, large drainage tubes collecting “blood-tinged fluid from each of my breast wounds.” For a week, she hosted “an around-the-clock party … in my glamorous attire of nightie-and-drains. “I hate to say it was like sitting shiva — thankfully this occasion was about life, not death – but shiva is the closest comparison I can make,” she writes. “Friends stopped by every day to visit, eat, and keep me company.”
Queller has no residual pain from the mastectomy, she says, no physical limitations, and barely noticeable scars.
When she has her daughter, she won’t be able to breastfeed, which, she says, “is disappointing.”
When her daughter grows up, Queller says, she will discuss the medical options for a young woman who may share her mother’s BRAC1 mutation. With advances in gene therapy, “in 30 years there will be a cure” for breast cancer, she says.
When she’s back here, Queller will resume dating. “I still hope to fall in love,” she says.
The Facebook messages from strangers keep coming in, usually a few each day. “I read your book,” they tell Queller. Many are facing their own mastectomies. “Pretty Is What Changes,” they write, “helped me go through the surgery.”
The message, a long intimate letter,” from the unmarried cancer survivor stands out.
At 34, she had lymphoma. She heard an interview with Queller on NPR, then went out and bought Queller’s book, which inspired her to consider having a child, even if she were not married.
“Maybe I can do this alone,” she wrote Queller.
The stranger is 18 weeks pregnant via artificial insemination, Queller says. “She’s having her dream. She’s so happy.”
So is Queller. When she read the stranger’s news, “I started to cry.”
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