Should She Take Tamoxifen?

\o7 "When I saw her scar for the first time, it looked like a large block of skin, folded over. I would sometimes sit in her room while she got dressed, seeing her place the prosthetic in her bra. Other people would take me places, to school, to gymnastics, but not her. She couldn't do it, she was too sick, especially after the chemo. Her hair fell out. I could hear her retching on the other side of the closed bathroom door, and it made me feel disgusted and revolted. I wanted to comfort her, but didn't know how."\f7

--Anya Booker, on watching her mother die of breast cancer

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The specter of breast cancer haunts Anya Booker, a 33-year-old Hollywood filmmaker and screenwriter. It permeates her life, shades her most intimate memories of childhood and emerges as a frequent theme in her work.

She was only 14 when she lost her 45-year-old mother, Poppy, to the disease, and 24 when her older sister, Toy--by then, her surrogate mother and closest friend--died of breast cancer at 34.

"It felt like it was my mother all over again. I was grieving both deaths at the same time," Booker says.

The death of her sister was not just about loss, as painful as that was, it also was about the disease--about fearing, with a growing sense of dread, for her own fate.

Follow the fragile thread of the women in her family: Her maternal grandmother was diagnosed with breast cancer soon after her mother died. She survives, but an aunt--one of her mother's sisters--also contracted breast cancer and recently died. Although Toy was actually a half-sister--the child of her mother from an earlier marriage--a deadly line seemed to run unbroken through her mother's side of the family. All proud African American women with a creative cultural heritage. All riddled with breast cancer. Would it reach her too?

Suddenly, she needed more than consolation. She needed some way to resist, to protect herself from the same killer, or at least a way to gain a sense of security about what might happen to her. She began keeping a journal, using a gift for words to chronicle the unthinkable.

Like Booker, thousands of American women who, because of family history or other risk factors, are at high danger of developing breast cancer are agonizing over whether to take tamoxifen. For nearly 20 years, tamoxifen has been an established treatment for breast cancer after surgery. But in October, the Food and Drug Administration approved the drug's use by healthy women at high risk of getting it.