In My Previvorship Era by Vanessa Federico

­­­­­You know that scene in My Cousin Vinny when Miss Vito, played by Marisa Tomei, explains her expertise in automobiles? The one where she has to validate her knowledge in a subject area based on her own lived experience and her family’s history with car mechanics?

“Well, my father was a mechanic. His father was a mechanic. My mother’s father was a mechanic.

My three brothers are mechanics. Four uncles on my father’s side are mechanics.”

You get the idea…

When I came home from the hospital after having my prophylactic double mastectomy, My Cousin Vinny was on TV. Not only is that scene iconic, but it got me thinking about how this connects to my own story as a previvor.

And while nobody, (that I know of), in my family is a mechanic, we do share something much more… genetics. Specifically, the BRCA1 gene mutation. Now if I were Miss Vito, having to validate my decision about why I chose to amputate my breasts, it would sound a little something like this:

“Well, my mother has the BRCA1 gene mutation. Her father had the BRCA1 gene mutation. My older sister has the BRCA1 gene mutation. My mother’s sisters both have the BRCA1 gene mutation.”

Again, you get the idea…

My name is Vanessa Federico. I am 30 years old, live north of Boston, and underwent a prophylactic double mastectomy after years of surveillance, a strong family history, and a known BRCA1 gene mutation. I am what is known as a “previvor”: someone who takes action to reduce or eliminate a genetic cancer before the cancer develops or is detected in his or her body. In other words, I am a proactive warrior/badass/babe who has outpaced my genetic predisposition to breast cancer.

The BRCA1 gene mutation puts me and anyone who carries it at a double, triple, and sometimes even quadruple risk for developing breast cancer and/or ovarian cancer. Let that sink in double, triple, quadruple the risk of the general population.

If that wasn’t enough to worry about, BRCA1 carriers, also have an additional risk for developing prostate, pancreatic, and melanoma.

Something that most people don’t know is that we ALL carry the BRCA1 and BRCA2 genes. BRCA genes are known as tumor suppressor genes, which means they play a role in helping repair growth and even prevent breast cancer. The name BRCA is an abbreviation for the BReast CAncer gene.

However, those of us in the BRCA babe club who carry a BRCA gene mutation, lack proper gene repair. So, in layman’s terms, the gene that is supposed to help prevent breast cancer actually invites growths to join the party instead.

As mentioned before, my BRCA1 gene mutation came from my mother’s side of the family. You can receive a BRCA gene mutation from either your mother or father, and it is truly a 50/50 chance of whether or not you will receive the gene mutation. For example, my older sister is also a BRCA1 gene mutation carrier, but my little sister is not - she received my father’s BRCA gene (the unmutated one). There’s no rhyme or reason, just genetics!

My older sister, Kristina, was the first in our family to undergo preventative measures in outpacing cancer. We are the first generation to get ahead of breast and ovarian cancer before it has a chance to get to us. And while that’s inspiring and full of hope for our future, many sacrifices have and continue to be made along the way.

The decision to remove both of my breasts at the ripe age of 30, was both very easy and extremely challenging at the same time. These polarizing feelings are the same ones that drove me to my surveillance appointments over the last six years and simultaneously kept me up at night thinking “Is that my normal breast pain before a period or is this the moment I find out I have the big C?”.

Of course, I wanted nothing more than to decrease my risk of developing cancer. For years, I felt as though cancer, specifically breast cancer, was an inevitable part of my future. My mother’s sister, my Auntie Katie, passed away in 2005 after a long battle of both breast and ovarian cancer. I know that if she were here today and she knew about her BRCA1 gene mutation, she would’ve gone under the knife in a heartbeat. And because she was the middle child on my mom’s side and I am the middle child as well, I felt this enormous sense of fate that maybe someday this is what will happen to me too. That may seem strange, impossible, crazy, and unrealistic, but at the end of the day it was how I felt and there was no telling me otherwise.

You can say that my Auntie Katie is a BIG part of my why. So is my mother, a two-time breast cancer survivor. So is my Auntie Nancy, also a breast cancer survivor. And so is my sister Kristina, a melanoma survivor, as well as a breast and ovarian cancer previvor.

They inherently left me with a road map of where my life could go and some major decisions to consider along this road trip, all of which I am extremely grateful for.

After speaking with my primary care physician, talking to my family about our health history, and seeking genetic testing and counseling; I ultimately found out I was BRCA1 positive on my 24th birthday. What I didn’t know then, but know now, is that I was always BRCA1 positive, but now I know about it and can do something about it.

As I entered my mid-twenties, a lot was happening within a short span of time. I got engaged, went for yearly screenings, lived through a global pandemic, postponed our wedding, adopted a dog, changed job locations, got married to my amazing and supportive husband, bought a house, etc.

And as the years of scanxiety after each MRI built up the question of, “When should I consider a double mastectomy?” loomed in the forefront of my brain. I knew that I wanted to start a family, but I also knew that waiting was no longer an option for me. I was left with a choice: start a family now and wait to have surgery and hope that cancer can just hold off, or have surgery now and remove my breasts so that I can be there for my family?

So, like any good old-fashioned decision that needs to be made, the pros/cons list came out, and I went to town. I considered every scenario, and every option, and ultimately the latter won. A prophylactic double mastectomy with nipple sparing and reconstruction was my next endeavor.

After recruiting my dream team and ultimately booking surgery, I felt an immediate sense of “Oh, shit…this is really happening.” The thing I said I knew I always wanted to do but didn’t know if and when it would be happening in 2023.

And so, I did what any sane person would do, applied for the Dana Farber Boston Marathon team. I had run three marathons before, but there was something about Boston, something about checking off a bucket list item, something about achieving one last thing fully as me before surgery that I just knew I had to do. Running the Boston Marathon had always been a dream of mine and never in my wildest dreams did I think I would be running this elite race weeks before my double mastectomy.

Ultimately, I knew that if I could train, run 26.2 miles, raise money for Dana-Farber, and cross the finish line on Boylston Street, I could walk confidently into the OR for my prophylactic double mastectomy. And the cherry on top? Both of my sisters also ran for Dana-Farber, a place where we sought healthcare, genetic counseling, genetic testing, surveillance, and so much more.

On the morning of my surgery, I was certainly nervous and anxious about the unknown. But as game time approached, I was smiling while putting on my johnny, knowing that I was taking my health into my own hands and freedom was just around the corner. I feel so empowered to share my story and know that by using my voice I can help others be empowered too.

Now that I am on the other side of this surgery, I can breathe easier and no longer feel the weight that once consumed me. There is freedom on the other side of fear.

Sometimes life places mountains in front of us. We can climb them, be intimidated by them, find an alternate route, or move them one stone at a time. The beauty in it is that the choice is ours to make. And in that journey, we can show ourselves and others just what we are capable of. My scars will forever remind me of the mountains that were moved and made me stronger along the way. If you find yourself in front of a mountain someday, know that you are not alone. Take one stone, one step, one decision at a time.

Vanessa Bramante

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