Joanna Rudnick's story, as told in her unblinking new documentary, In the Family, is an intensely personal one. As the Chicago filmmaker found in making her film, it is a story shared — in their own individual ways — by thousands of other women and even a few men. Joanna, whose family has a history of breast and ovarian cancer, took advantage of breakthroughs in genetic research and tested for the recently isolated BRCA genetic mutation. Those with BRCA mutations have up to an 85 to 90 percent lifetime chance of developing breast cancer, and up to a 50 to 60 percent lifetime chance of developing ovarian cancer. At age 27, Joanna tested positive.
Such knowledge would be simply devastating if it did not also offer treatment and hope. But the only true preventive treatments are devastating in their own right — radical mastectomy (total removal and reconstruction of both breasts) and oophorectomy (removal of the ovaries, ending the chance of becoming pregnant), preferably by age 35, and certainly by age 40. Such a course would be a blow to any woman, whatever her age or circumstances. But for a young woman like Joanna, still searching for love and looking forward to marriage and children, the cure seems nearly as daunting as the looming disease.
When Joanna tested positive for the BRCA mutation, she set out to make a film about the science behind BRCA, but even more about the impact of this new medical knowledge has on women's lives. Shying away from putting her own life and emotions at the film's center, at first she searched for a young, unmarried woman like herself to be the film's primary subject. But having the BRCA mutation has become something that is often hidden, especially among younger women, because of the negative impact it can have on women's prospects for love, marriage and children. Unable to find a suitable subject, Joanna bravely stepped into the role.
The BRCA mutation runs in Joanna's family. Two great-grandmothers died from ovarian and breast cancers. Joanna's grandmother Ethel developed breast cancer at age 56; her mother, Cookie, was diagnosed with fallopian tube cancer at 44. Joanna's older sister, Lisa, a radiologist who diagnoses breast cancer and drove the process to get tested, turned up negative for the mutation. Inheritance of the genetic mutation is not a given, but there was no doubt that Joanna was a candidate for the test.
But once you know, what do you do with the information? Despite the assurances of doctors and researchers, who see the life-saving potential of genetic testing, Joanna knows her future has been turned on its head. Still in the spring of her life, she must face life-and-death choices generally reserved for old age. She must ask herself the searing question, "How much do I sacrifice to survive?"
In the Family follows Joanna's journey to learn from the experiences of other women confronting BRCA. Poet Martha Haley of Chicago is a three-time breast cancer survivor and founder of Celebrating Life, a breast cancer support groupfor African American women. She confronts head-on the fact that black women are much less likely to get genetic testing for BRCA, not only because of disparities in wealth and health care, but also because of the distrust many African Americans feel toward the medical establishment. Martha speaks out, urging women to get tested. "When you get diagnosed with breast cancer and you are part of a poverty-stricken community, it can be like, 'Why should I even bother?' I want to address that," she says.
Linda Pedraza of Boston was 10 years old when her mother died of ovarian cancer. Seven years later, her brother Gary fought bladder cancer. As Linda and her siblings started having families, they hoped cancer was in the past. Unfortunately, it is very much in their family's present. Linda was diagnosed with ovarian cancer at age 42, and she and her siblings all tested positive for BRCA. In the Family finds Linda enduring another round of treatment, this time for metastatic breast cancer. She tells Joanna, "In spite of how awful it is to feel less than female, being alive is what matters. In retrospect... I would have had all those surgeries. It may not be the ideal life that you want, but it's life." Now, Linda's greatest concern is for her 16-year-old daughter Nicole, who is still too young to be tested for BRCA.
Olga Flores, age 32, is a professional singer and single mother who knows that BRCA runs in her family — both her mother and grandmother battled cancers caused by the mutation. Though at first paralyzed by the thought of testing for the "breast cancer gene," Olga finally decides to do it. She says: "My grandmother died at age 39 of ovarian cancer; I'm her namesake. When my mom got breast cancer, it ripped me apart. And so if I were to have this gene, I would just be, 'No wonder.'" Medical professionals, including Dr. Mary-Claire King of the University of Washington, whose determination to fight breast cancer in women led to the discovery of the BRCA mutation, lend context to these women's stories.
Through it all, In the Family documents Joanna's own struggles — including her up-and-down relationship with her boyfriend, Jimmy, who accepts and supports her and yet resists letting cancer — and the film itself — dominate their lives. The course of their relationship brings to the forefront a host of dilemmas that testing positive for BRCA presents — especially for the young. At what point in the course of a relationship do you reveal the truth? How do you deal with the time pressures to settle down and have children? How does a prospective spouse deal with knowing that his wife will eventually either have cancer or be physically altered? What is the responsibility for passing on the mutation to another generation? And while wrestling with these questions, Joanna must keep asking just how long she dares to wait before taking action.
In the Family is a timely inside look at the human impact of new genetic research, where science's ability to diagnose and even predict disease sometimes outruns its ability to offer cures or even less-than-draconian therapies, as in the case of BRCA. In the Family is also a poignant account of one young woman's striving to live fully in the shadow of the cancers that afflict women's lives.
"I had no intention of 'starring' in my own movie," says director Joanna Rudnick. "Actually, I was as reluctant as anyone to 'come out' on camera because I was afraid it would make falling in love and having a relationship too difficult. But I realized this story had to be told not only factually and objectively, but in the most personal way, and that I could do that best by using my own story."