Facing A Legacy

René Syler moves easily through the New York City luncheon crowd before taking her place at the front table in the newly renovated ballroom of the Plaza Hotel. In a moment, the nationally known anchor and breast cancer advocate will be introduced as the host for the 2008 American Cancer Society Mother of the Year luncheon honoring Cynthia Lufkin, a friend of Syler’s who has been active in breast cancer initiatives in New York City since her breast cancer diagnosis in 2005.

In her bright pink jacket, Syler is stunning, with a presence both practiced and inborn. The crowd listens intently as Syler talks about breast cancer’s impact on her life, beginning with her father’s breast cancer diagnosis some 35 years ago, her mother’s breast cancer diagnosis in 1997, and her own endless cycle of mammography and biopsy that began in 2003 and ended in 2007 when, after numerous biopsies had left her soul and her breasts “shredded,” Syler decided to have a bilateral prophylactic mastectomy and immediate reconstruction.

Syler adopted breast cancer as a cause early in her broadcast career, becoming a familiar face in Dallas, not only anchoring the local news but also at breast cancer events where she served as the mistress of ceremonies. She became the recognized emcee for what were then the Susan G. Komen Breast Cancer Foundation annual luncheons in the ’90s—and often her mother, Anne Syler, would attend.

Then Anne was diagnosed with breast cancer in 1997, and René jumped in to manage her mother’s diagnosis and treatment while her sister, Tracy Syler-Jones, lent long-distance support from her home in Alabama. It was clear to all in the community that from the moment her mother was diagnosed, René’s commitment to the cause elevated. Now it was personal.

Anne Syler lives in Fort Worth, Texas, where her second daughter, Tracy, serves as an associate vice chancellor for marketing and communication at Texas Christian University after moving from Alabama to be closer to her mother and sister. One has only to meet Anne to see where her daughters get their independence, beauty, and determination.

Anne Syler’s distinctive beauty comes from her parents, a mother who was French Canadian and Native American and a father who was African-American and Irish. Her independence also came from her parents, she says, but it was honed by the military. Indeed, now a retired Air Force master sergeant, Anne earned her wings in the mid-’50s while still in her early 20s as a military flight attendant on Air Force transatlantic flights.

When Anne married Bill Syler in her late 20s, she left the military, earned her college degree, and taught school while raising René and Tracy, who is two years younger. When René was 10, her father was diagnosed with breast cancer and underwent a mastectomy. René doesn’t recall much about his diagnosis since it was not discussed in the family. Her father died of heart disease 13 years later.

When René was 17, her parents separated and her mother decided to return to the Air Force to pick up where she left off, ultimately retiring when she completed 20 years. Anne says both her daughters supported her decision to return to the military, recalling that René told her how proud she was of her. She said, “ ‘All these women, when their husbands leave, they sit around and do a pity party thing, and here you are in a career. You’re getting ready to go places and do things. I am so proud of you.’ ”

When Anne learned she had early-stage breast cancer, she was living in San Antonio, and René became her “mother,” Anne says, despite a busy on-air schedule and being very pregnant with her second child, Cole. Anne says René called her contacts for information to be sure her mother was making the right choice in choosing a lumpectomy. In other interviews, René has said that when her mother told her she had breast cancer, “it took the wind from my lungs, because if there were ever an unlikely candidate for breast cancer, it would be Mom.

“She ate well and exercised long before it was fashionable to do so, didn’t drink excessively. At the time, she was the picture of health,” René says.

Still independent, Anne’s only concession to her cancer and her age has been to hire someone to clean her house and tend to her yard. She recently finished a nutrition course offered by the state and will soon teach nutrition at health fairs. Anne says her commitment to exercise and good nutrition was also something René inherited, writing to her mother after her daughter, Casey, was born to thank her for being adamant about healthy living—and eager to share the information with others.

It came as no surprise to either Anne or Tracy that René would choose to go public with her mammograms, biopsies, and ultimate choice for prophylactic mastectomy.

“That is René,” says Tracy. “Her whole life has been about helping people and offering information so people can live their lives better. And it was therapeutic for her having people go through this with her. After she went public, there seemed to be lots of other women who also came forward.”

Syler, now 45, had a baseline mammogram at 29 when she found a lump in her breast. She increased her vigilance with annual mammograms after her mother was diagnosed. So when her 2003 mammogram came back with suspicious areas, Syler acted quickly.

Having moved to New York City the year before to become the first African-American woman to host a network news program on CBS’s The Early Show, she sought out breast surgeon Virgilio Sacchini, MD, at Memorial Sloan-Kettering Cancer Center, whose research focus is high-risk women. Indeed, before moving to New York, Sacchini had been involved in clinical trials in Italy to evaluate conservative surgery and was also deputy director of the breast department at the European Institute of Oncology.

Because Syler’s mammogram showed a pattern indicating deposits of calcium (technically called microcalcifications) in the left breast, a needle/core biopsy was performed. In the samples of tissue removed with the needle, the pathologists saw some atypical cells, cells different from normal breast cells. For this reason, Sacchini chose to perform a surgical/incisional biopsy to have more tissue for examination.

A noncancerous fibroid adenoma was removed, Syler says, and the calcifications, which had shown up as “buckshot” on the mammogram, revealed atypical hyperplasia, a precancerous condition that raised her odds of getting breast cancer.

“With the needle biopsy of the microcalcifications showing atypical cells, we know that we have a 25 percent higher risk of finding breast cancer when we remove more tissue,” Sacchini explains. “What we found in the additional tissue was more atypical cells, fortunately, not breast cancer. But the atypical cells mean an increase in the risk of developing breast cancer in the near future.”

Sacchini says after surgery Syler met with a geneticist and was tested for the BRCA1 and BRCA2 genes. The test came back negative. She and Sacchini discussed her risk and her options, including chemoprevention with the anti-estrogen medication tamoxifen, which can decrease the risk of breast cancer.

“But it’s questionable if it can reduce the risk in women with high family risk because cancers in these women are often hormone receptor-negative, and tamoxifen prevents more hormone receptor-positive cancers,” says Sacchini.

Syler also had to consider the potential side effects of tamoxifen, including increased risk of endometrial cancer and blood clots.

Sacchini also discussed prophylactic mastectomy with Syler, which he stresses is never something urgent or a choice that should be pushed on a patient. “It is a thought-out operation by the doctor and the patient.”

Syler chose the final option they discussed, wait and watch. Sacchini increased her screening to every six months, alternating mammography with MRI scans.

In 2004 and 2005 her mammograms again showed microcalcifications in the left breast, necessitating two more surgical/ incisional biopsies that still revealed atypical cells. Sacchini says that because the microcalcifications involved several areas of the breast, each surgical biopsy meant Syler lost more breast tissue and her breasts became more disfigured. She was also, by this time, distressed and frightened about developing breast cancer, Sacchini says.

In 2006 the left breast again showed irregularities—but this time there were three different locations, each the size of a golf ball, Syler says. “The fourth biopsy killed me. It put me over the edge,” she recalls.

When the swelling subsided, the left breast was about a half cup size smaller than the right and had a large scar beneath it. Syler says she was exhausted emotionally and could not face the idea of more biopsies when she already saw two breasts that were different sizes, scarred, and misshapen. “It was awful.”

I asked her if she wanted to go through life wondering that it might be cancer. She said 'That's where I am, Mom. Why should I do that? I have two kids and I want to see them grow up.'

Sacchini told her the only option to correct the shape of the breasts was implants, Syler says, and that choice meant needle/core biopsies would never be an option—biopsies would all have to be surgical/incisional, meaning the loss of more tissue.

Syler says she knew it was time to get off the “will I get breast cancer?” merry-go-round and have bilateral prophylactic mastectomy.

Anne says she and Tracy offered support. “I knew the trauma of having to go through an exam and biopsy and then wait for the answer,” Anne says. “I asked her if she wanted to go through life wondering that it might be cancer. She said, ‘That’s where I am, Mom. Why should I do that? I have two kids and I want to see them grow up. It doesn’t make sense to wait another year and see whether I develop cancer.’ ”

Syler took the journalistic approach to considering mastectomy by gathering information and interviewing anyone associated with prophylactic mastectomy, including plastic surgeons, women who had undergone the procedure, and mental health professionals. She chose a plastic surgeon to work with Sacchini and discussed the nipple-sparing mastectomy he would perform, an increasingly popular technique that allows the preservation of the nipple and the areola with its resulting cosmetic advantage.

“No matter how many people you talk to or how many weigh in, it’s your decision,” Syler says. “I found out as much as I could; I talked to plastic surgeons and interviewed people and looked at pictures. I worked hard at having all the questions answered before I laid my head on the table.”

Syler laughs at the number of show-and-tell moments women offered her. “Women want to show you how good it looks. I had been talking about this for a couple of years, and I had talked to women who had had it done, and they were all willing to show their surgery. You are curious, so you want to see.”

Weeks before her surgery, Syler was fired from her CBS anchor position after four years. She was now out of a job, facing surgery, and in the middle of renovating a 104-year-old farmhouse in Chappaqua, New York, an hour outside New York City where she and her husband, Buff Parham, a vice president with Univision, and their two children, Casey and Cole, had settled.

Syler underwent surgery on January 10, 2007, waking with her nipples and areola intact and expander sacks placed under the muscle of each breast. Over the next few weeks the surgeon would fill the sacks until they reached the desired size and then replace them with permanent implants in a second procedure.

In a journal she kept on her surgery, Syler wrote that the man she really needed to thank was her husband. “Even though I called him ‘Nurse Ratched,’ because, trust me, he did have his moments, he came through like a champ. I almost forgive him for lying in my bed when they hauled me up from recovery and listening to FOX News Channel and eating potato chips from a crinkly bag when all I wanted was soft music and even softersounding food. I do love that man.”

A few days later Syler received the pathology report. There was no cancer, but there were several areas of atypical hyperplasia in the right breast—not the breast that had undergone repeated biopsies. “It was the right time to act,” Syler says.

Beginning with her first biopsy scare in 2003, Syler decided to go public, taking 2.3 million CBS viewers through her biopsy in a three-part series that won the national best anchor award from the American Women in Radio and Television.

“I wanted to motivate women to take care of their own health,” Syler says, “and it was amazing how many women watched the show during that time and let me know they got their first mammogram because of it.”

After her surgery, Syler talked about her experience in interviews on Good Morning America and Oprah.

Syler says going public was the continuation of the promise she made when she started working unofficially with Susan G. Komen for the Cure—to use her voice to empower, educate, and inform women about breast health. She formalized her relationship with Komen almost two years ago, becoming a Komen Ambassador and co-chair of Circle of Promise, a program to educate African- American women about early detection.

“Breast cancer is more deadly for women of color,” Syler says.

Syler has received numerous affirmations for her public disclosures. In June 2008, 18 months after her surgery, Syler received a note from Sacchini about a 32-year-old African- American woman who had a strong family history and decided to have a bilateral prophylactic mastectomy after seeing Syler on Oprah. Sacchini added that he found a 1.5-centimeter breast tumor that had not been visible on the scans.

Syler says she put the note down and cried.

“I thought back to that horrifying time. Again this reminded me how important it was to share that information.”

After her mastectomy, Syler and Tracy met for lunch. “She said, ‘Here look, feel these,’ ” says Tracy, laughing. “I put the back of my hand against her new teenage breasts and then realized people were looking at us.”

Tracy says her sister’s initial biopsy was jarring, but that now she is confident she did the right thing. For herself, Tracy says she is alternating mammography and MRI every six months and has had genetic counseling, although she has not been tested for the BRCA genes since René tested negative.

“Lots of people ask if I am going to have the surgery,” says Tracy. “It’s an individual decision and I have only had to have a needle biopsy and not incisional ones.” In addition, she says she is confident in her physicians at the University of Texas Southwestern Medical Center at Dallas, where she is being tracked.

Syler knows that while she has greatly reduced her risk of breast cancer, it is not 100 percent. Her body image, she says, has not been an issue.

“I may be part of the rare population, but I don’t feel any difference. I don’t look at my body and go, ‘Oh look, I don’t have breasts.’ I had nipple-sparing mastectomy and my chest looks the way it did, although my breasts don’t move the same way.”

After surgery Syler prepared for the tour for her book, Good-Enough Mother: The Perfectly Imperfect Book of Parenting, which was published in March 2007.

In the book Syler explores the challenges of today’s mothers, explaining how she has managed a career while raising two children and being married. In June, Syler began hosting It Moms on Parents TV, a channel available through Comcast. It Moms is Parents TV’s first long-form show that features mothers from across the country as they balance work, family, and home—a position Syler knows well.

Syler has never done just one thing at a time, says Anne, recalling how her daughter worked her way through California State University as a waitress, earning a degree in psychology in 1987. She began the master’s program in psychology and then decided it wasn’t for her, calling up a local television anchor to inquire about how to break into television. While still waitressing, she worked weekends at the station, took some introductory journalism classes at a junior college, and six months later got a job at the CBS affiliate in Reno, Nevada. Within the year she had moved to Birmingham, Alabama, as a weekend anchor. In 1992 she moved to Dallas, a top 10 market.

At the end of the ACS luncheon Syler heads for Chappaqua. She arrives and carefully steps over a pile of construction debris into the kitchen where she is met by Casey, 12, and Cole, 10. Syler talks with each child while trying to manhandle Olivia, the family Labrador retriever, in what could be a scene from a television sitcom.

When Syler talks of why she did a preemptive strike on breast cancer, she cites her family as the primary reason. “I have to be here to break up the fights,” she says, laughing.

Syler approached her surgery decision with the children, she says, the way she and her husband do everything—openly and honestly. Both children know the details and have had age-appropriate questions. Cole asked her if she could die of “plastic” boobs.

Both children know breast cancer is a risk, particularly Casey, who asked if she would have to have the same surgery. “I told her hopefully not, because I don’t know,” Syler says. “I didn’t say, ‘no, oh no,’ because I don’t know. I told her that was why I worked with Komen.”

Today, almost two years after surgery, Syler says she is happy with the decision, and if she has any regrets, it’s that she didn’t do it sooner.

“It has been so freeing for me. I couldn’t bear going back in and having another biopsy. The bottom line was if I didn’t do it then, it would have been this year or next year because there wasn’t enough tissue to go on the way we were.”