Health

By LAUREN GROVER
Staff Writer

Her hearty laugh is bold, like her ink-black hair that refuses to gray, and encircling Margo Adams' small, graceful frame are two long scars that meet at her spine and curl around to her chest.

For Margo, cancer wasn't a shock. At 18, she watched her mother fight and lose to it. And, like her mom, the disease has always been with her, a part of her very make-up.

"Cancer was never 'Poor me,'" said Margo, 59, sipping wine over a plate of sushi on Tuesday. "My mother died of it at 42. I was 18, my brother was 15, and we didn't get it. I wanted to outlive her."

To nix the matter, Margo had an elective hysterectomy in 1990 soon after her 41st birthday.

But 13 years later she was diagnosed with breast cancer and treated with a lumpectomy, chemotherapy and radiation.

"It was really hard," said her daughter, Susan Adams, 24. "She was in the middle of everything and didn't want to be a burden on anyone. I was a senior in high school, the same age she was when her mother died. But she's really tough."

Margo kept wondering if there might be another chapter to her cancer battle. In 2007, she turned to gene testing.

"I wanted to know," she said emphatically. "I'm fine with knowing; I think knowing is being proactive about my own health."

A $3,300 gene test in December 2007 revealed an alteration in her BRCA2 gene: she had a 70 percent chance of breast or ovarian cancer in her lifetime.

Her ovaries gone and one bout of the disease over, Margo's risk of a new breast cancer still hung at 65 percent. There was no way to ignore it.

"I decided when I was driving home (from getting the results)," she said. "I did not want chemo again. No way."

An elective double mastectomy would cut her risk of breast cancer to 10 percent or less - it meant relief in her mind, she says.

So she scheduled it a year out. Her four kids - Susan, Brian, 29, and twins Kathryn and William, 20 - were at milestone ages too important for a mastectomy break.

"The twins were starting college, doing Rose Festival, there was a baby coming (for Brian and wife Kelly). It had to wait," she said.

On Feb. 8, Margo would admit herself to M. D. Anderson Cancer Center in Houston. And like any of the dozens of parties she's helped throw, it would involve friends, family, a few outfits (oversized button-ups), her nails being done and her hair cut.

In January, she talked with ease about the like any of the dozens of parties she’s helped throw, it would involve friends, family, a few outfits (oversized button-ups), her nails being done and her hair cut.

In January, she talked with ease about the double mastectomy, a surgery at which most women might cringe.

“I’m not waiting to see if I get sick again,” she said. “I don’t care how bad recovery is.”

Because of an allergy, Margo was not a candidate for silicon or saline implants as part of reconstruction — instead, back muscles would be used as replacement breasts.

“I’m hoping I’ll lose 20 pounds,” she said in January. “And no more bras! Boy does that make me happy.”

Susan said her mom has always displayed this sort of resilience.

“She just figures if this is as bad as life gets, she can handle it,” Susan says.

Soon after her gene alteration was revealed, Susan and Brian got tested.

The altered gene wasn’t handed down to Susan. But Brian did get it, and will have to monitor his increased risk of prostate cancer and the possibility of handing it down to his offspring.

“It was a huge relief I didn’t have it,” Susan said. “It would be an issue; I would need to have kids faster.”

The day before surgery, Margo said her only concern is pain control.

“Lots of drugs,” she said, smiling. “I’m not wavering on why I’m doing it. I’m minimizing my breast cancer chances. I’m doing what I can do.”

Dr. Bob Fender, a general surgeon with the East Texas Medical Center Breast Cancer Center in Tyler, said recommending bilateral mastectomies for women who suffer from altered BCRA genes isn’t uncommon.

“In Margo’s case she had a long time to reflect on it, and the decision she made is quite different than other women’s,” he said.

Preventative mastectomies are becoming more common, Dr. Fender said. More women each year who are candidates for mastectomy because of cancer in one breast are choosing to include the other.

“The percentage who need a mastectomy and opt for contra-lateral prophylactic mastectomy on the other side has tripled in the last five years,” he said.

Kelly Adams, wife of Margo’s son Brian, said she’s known several women who have chosen mastectomies based on family history.

“I’m still so nervous for her,” Kelly Adams said. “But it’s not strange — I’ve known women who’ve done it, and then their daughters, too, because so many in the family had died of breast cancer.”

At 4 p.m. the day before surgery, Margo strolled into Prestige & Creation and greeted owner and French stylist Claudie Jasper with a hug.

“I’m getting my breasts done,” Margo said. “Well, a mastectomy. So I need it real short. I won’t be using my arms for awhile.”

At the salon, it was impossible to tell Margo was just hours from a more than eight-hour surgery followed by a three-week recovery in M. D. Anderson and at least two months of rehab back in Tyler.

“It’ll be a process,” she says about recovery. “It depends on how vigilant I am about exercising. I’ll have to get my strength back, breaking adhesions, using different muscles.”

The choice for mastectomy and especially reconstruction depends heavily on age and self-image, Dr. Fender said.
“I’ve had patients who say, even if I have an altered gene, I don’t want my breasts removed to prevent cancer,” he said on Wednesday. “Often those are single women.”

Before sunrise on Feb. 8, Margo reclined in a pre-op bed at M. D. Anderson, her four children and best friend, Debbie Roost, circled around her. Susan, William and Kathryn flew in from out of state.

It was quiet. Then the group acclimated to the medical setting, to Margo in a hospital gown and IVs snaking from her arms. Soon their family dynamic was in full swing.
“Did you know mom lived in Las Vegas?” Brian asked his younger siblings.

“You’re not wearing your glasses,” another commented.
“Well, I can’t wear them into surgery,” Margo smirked.
“What do we do (while you’re in surgery), hang out?” Kathryn asked. Everyone laughed.

“Susan’s the fainting daughter, so you’ve gotta watch her,” Margo said.

Susan said the elective double mastectomy was easier to swallow than when Margo was diagnosed with breast cancer in 2003.

“It’s a different type of deal,” Susan said. “Five years ago she was sick, it was scary. This time she’s doing it to stay healthy.”

At about 6 a.m. it was hugs and kisses, then a few repeats. The kids sauntered off together with Debbie, into the hallway where Debbie pulled out a long list of phone numbers.

“Yep, I’m gonna call and let all of them all know how she’s doing during surgery,” she nodded.

Debbie was the first shift of Margo’s in-hospital support. About four other friends would tag-team to be with her day and night during her three-week stay.

Margo is strong, but she’s realistic about her need for a friend during the tough few days following her double mastectomy, Debbie said.

“She has really positive people around her, all kinds of upbeat people, and that really makes a difference,” she said.

Margo Adams stands in front of a wall in her kitchen covered in family photographs in February before her elective double mastectomy.
((Staff Photo By Herb Nygren Jr.))