by Jessica Mosby
– USA –
If you could know that you were at risk for a terminal illness, would you want to know? And then what would you do next if the news confirmed your worst fears? At the tender age of 27, Joanna Rudnick faced this very conundrum when she tested positive for the BRCA genetic mutation. Her chances of developing breast cancer subsequently went from about 11 to 12 percent to a devastating 80 to 90 percent, and her chances of developing ovarian cancer shot from about 1 to 1.5 percent to 50 to 60 percent.
Rudnick, a scientific journalist, chronicles her struggle as she comes to terms with her altered gene and her uncertain future in the very personal documentary In the Family. The film is currently playing on PBS as part of the Point of View series.
After her mother Cookie, an ovarian cancer survivor, mapped out a family tree riddled with cancer, Rudnick decided to be tested for the BRCA genetic mutation. Inheritance is not a given; while Rudnick tested positive for the gene, her sister Lisa tested negative. But testing positive for the BRCA genetic mutation means that you could pass the altered gene on to your children, thus increasing their risk of developing cancer.
The positive diagnosis definitely took a toll on Rudnick’s psyche. She “used to be more open and adventurous, not thinking about the future,” but then her life became centered on the real possibility that she could develop cancer and die. She didn’t tell anyone her results because she was too scared, and even paid for the test herself because she didn’t want to run the risk of her health insurance provider finding out and possibly discriminating against her if she did test positive.
To confront the loneliness and fear that she felt, Rudnick decided to make a film about her own experiences as they were unfolding four years after her initial test. The result is a very thought-provoking look at advancing medical technologies that have the ability to save lives, but also derail people from living in the present.
If you learn in your mid-twenties, as Rudnick did, that you are significantly more likely to develop breast and ovarian cancer your options are limited. You can either do nothing, or have dramatic preventative surgery – a mastectomy (removal of your breasts) or oophorectomy (removal of your ovaries) – by your late thirties. And all of this is only possible if you have the $3,000 to have the BRCA test in the first place.
Throughout the film, Rudnick wavers between her strategy of regular medical examinations, or the alternative of removing her breasts and ovaries. Preventative surgery would stop her from worrying about developing cancer, and it would also mean that she could never have children – an especially difficult decision for a single childless woman who wants to have children, like Rudnick. Her emotional struggle is sadly characteristic of many women who learn they have a BRCA genetic mutation, but are unsure of how to proceed.
A film about a potential cancer diagnosis hardly seems like a good time, but In the Family is actually a very engaging 84 minutes of documentary filmmaking. Rudnick is able to clearly explain medical jargon without losing the humanity of the women she candidly interviews. Will single mom Olga Flores test positive for the BRCA genetic mutation, and then have to face an uncertain future with her young daughter? Will the three Hanke sisters all test positive for the BRCA mutation as their mother has? Rudnick keeps you interested in all of the women she profiles by keeping you on the edge of your seat.
For all of the sobering facts, the film is not depressing; rather, the women Rudnick profiles (herself included) are the essence of empowerment. After feeling overwhelmed by the amount of information available, Rudnick contacted Facing Our Risk for Cancer Empowered (FORCE), and was then able to meet with other strong women who have faced the same difficult decisions – all with grace and humor. You can’t help but laugh along with the cancer survivors who gamely pose topless for a girl of the month calendar at a FORCE convention. The documentary probably contains the most topless women of any program ever shown on PBS.
Rudnick lets it all hang out by simultaneously documenting her emerging relationship with new boyfriend Jimmy. The two met after her positive diagnosis, but Rudnick’s opening line is not “Nice to meet you. I have the BRCA genetic mutation.” Instead, after their first date Jimmy does an internet search and learns about her documentary in progress, which is fitting since they met online. The romantic relationship is filled with all of the happiness and unpredictability of new love – everything is just significantly more emotional and difficult as Rudnick tries to come to terms with her altered gene.
The film is able to question the lofty philosophical and ethical nature of genetic testing on a very personal level because In the Family is really Rudnick’s story. Filming yourself at your lowest point is hardly ideal, and to her credit, Rudnick never sugarcoats it. She earns your respect through her candid and lovable nature; at times she is very neurotic, but really she is just honest about her feelings.
In the Family will break your heart, make you laugh, make you cry, and ultimately leave you pondering, What do you do when you think you have all the time in the world, only to learn you’re already living on borrowed time?
About the Author
Jessica Mosby is a writer and critic living in San Francisco, California. In the rare moments when she’s not traveling across the United States for work, Jessica enjoys listening to public radio, buying organic food at local farmers markets, trolling junk stores, and collecting owl-themed tchotchke.
I was diagnosed with cancer at age 27 and have since gone on to interview young adult cancer patients across the United States for my book Everything Changes: The Insider’s Guide To Cancer In Your 20’s and 30’s.
A high number of young adults I spoke with said if they could go back to the beginning and choose whether or not to get cancer, they would choose to go through this again. I was shocked by these responses and firmly hold a contrary perspective. I certainly would choose to not have cancer had I known about it before hand.
I understand that my conversations are hypothetical; the young adults and I who were in conversation can not turn back time. And, even if we could go back, it is very different to know for certain you will get cancer versus being left with the nagging 80% odds that leave your mind in a horrific, perpetual limbo.
I want to say unequivocally that I do not envy Rudnick’s dilemma. But, somedays I do.
Kairol Rosenthal
Everythingchangesbook.blogspot.com
If you would like more information about the film and the filmmaker, here is a great interview with Joanna Rudnick on Talk of the Nation. Please note, the interview does include a few spoilers.