Excerpt: 'Promise Me: How a Sister's Love Launched the Global Movement to End Breast Cancer'

Sept. 13, 2010— -- When her big sister was dying of breast cancer, Nancy G. Brinker made her a promise.

She vowed to end the silence, the stigma and the shame enshrouding a disease that at that time in the late 1970s, no one dared utter out loud. She also promised to cure breast cancer once and for all.

After Susan G. Komen lost her battle with the disease at the age of 36, Brinker set out to make good on her promise, founding Susan G. Komen for the Cure, which has become one of the world's most influential charities for research into the causes and treatment for breast cancer.

More than 30 years after Komen's death, Brinker's memoir, which comes out Tuesday, brings to life the woman whose name has become synonymous with pink ribbons and hope. It also tells the story of Brinker's life and her efforts to build the groundbreaking charity.

Read an excerpt from the book below, and head to the "GMA" Library to find more good reads.

Chapter 1

Where Will Meets Way

My waking memories of my sister have grown hazy over the years,but Suzy still passes through my dreams as animate and vividas a migrating butterfly. Her face is fresh and full of energy, her hairwindblown but still beautiful. In a freshly ironed skirt and patent leatherballerina flats, she defies gravity, scrambling over a pile of slick rocks,Roman ruins stacked like unclaimed luggage on a hilly roadside inSouthern Spain.

Suzy, be careful, I call as she climbs higher.

Oh, Nanny, she waves me off , mugging for the boy with the camera. .

(Boys could never keep their eyes, or cameras, off her.) He tells Suzy tosmile. Say queso! But she's already smiling. In studio and fashion photos,she was always slightly Mona Lisa, never haute couture haughty. Almostevery candid photograph I have of Suzy seems to have been snapped justas she's bubbling up to giggle, that precise moment when you can seethe laughter in her eyes and feel the active upturn of her mouth, but thenot- quite sound of it is forever suspended in the air, teasing like the unplayedeighth note of a full octave. Even in the dream, I ache for the unfinished music of her life.

Back home, Suzy would write something silly on the back of the photo of the Roman ruins— I swear, it was like this when we got here!— while I'd carefully record the date and precise location where the picture was taken. I'm simply not gifted with silliness like Suzy was. I appreciate it as an art form, and I try not to be frustrated by it, but gifted with it? No. I am not.

Suzy wasn't serious or "bookish" like me, but all her teachers loved her, and I always thought of her as the smart one. In addition to her savant silliness, she was gifted with emotional intelligence, empathy, our mother's generous heart, an unfairly fabulous sense of style, and a humming, youthful happiness that made her naturally magnetic. She had ashy side, but people loved her to her dying day because she was just so much fun to be around.

I can be a bit of a task to be around, I'm afraid. I have no talent forsitting still. I'm not capable of pretending something is fine and dandy,when in fact it's not. If something needs to be said, I'm compelled tosay it, and I do it as diplomatically as I can. But let's face it, candor's lessendearing than coquettishness on any playground. My gifts were sturdyconstruction, a stalwart sense of justice, and the ability to whistle, ridehorses bareback, and skip stones over water as well as any boy. I was anatural bridge builder. Even as a little girl, I was the ambassador betweenmy high- spirited sister and our rightly starched father. She was threeyears older, but when Suzy was grounded, I was the hostage negotiator.When Suzy exceeded her curfew, I was the peace envoy.When Suzy died, my life's work was born. Her meaning became mymission.

Born on Halloween, 1943, in Peoria, Illinois, a gentle and generousplace that embodies the very soul of Americana, Suzy was three when Icame along in December 1946. Mom says she peered at me over the edgeof the bassinet and said, "Well! She's quite a character."

We were thick as thieves from that moment on. Suzy was always a queen bee in the neighborhood gang, and I was thrilled to be Suzy Goodman's little sister. I was her entourage, her liege, her cheerful sidekick, ambitiously pedaling my tricycle in the wake of her fleet- footed, inventive escapades. I can't remember a single instance of her telling me to buzz off or leave her alone or go play with the other kindergarten babies so she could hang out with the big girls who had more sophisticated things to do.

As our mother ages so gracefully, I can't help thinking what a couple of grand old ladies Suzy and I would have been together. That was our plan from the time we were little girls. My sister and I expected to age gracefully, set up housekeeping, cultivate a nice cutting garden, and sit in lawn chairs, watching our grandchildren play. We never discussed the fate of our beloved spouses; we just naturally assumed we'd outlive themin some "God's in his Heaven, all's right with the world" kind of way. It never crossed our minds that we'd be hip- broken or infirm. Not us. We'd be the spry old dames delivering Meals on Wheels, organizing holiday toy drives, knitting mittens for the underprivileged, quilting lap robes for all the tragic polio children.

The muggy summer of 1952 teemed with mosquitoes and clingy midwestern humidity. The school year ended (I was fresh out of first grade, Suzy liberated from fourth), but instead of that lazy, hazy wide- open summer feeling, we found ourselves in a world of closed doors and shuttered windows. It seemed to Suzy and me as if the city ofPeoria had pulled into itself like a turtle, afraid to poke so much as a toeout to do anything. The ice cream parlor and candy store closed up shop.The streets and sidewalks felt muted and unfamiliar. Women hurriedthrough the grocery store, holding the cart handle with a fresh hanky ordishcloth. We'd already been told there would be no movies, no carnivals,no concerts in the park. When Mother told us the municipal poolwas closed, Suzy groaned.

"What about the lake?" she asked.

"They're letting a few people swim there," said Mother. "Invitationonly."

I raised the possibility of the swimming pool at Uncle Bob and AuntHelen's house or the wading pool at the park or even our little plasticpool in the backyard, but Mother shook her head.

"Dr. Moff et says children can get polio from going in the water.""Clean water right out of the hose?" I said skeptically. "How wouldthat give a kid polio?"

"I'm not sure," said Mom. "It's a virus, and it's very contagious. Nowscientists are saying not to swim. I saw it in the newspaper. You girlsshould tell the other kids. Help spread the word about that. Even if itlooks perfectly clean— and I don't care how hot it is— you girls don'tgo near the pool. Understand?" And knowing us as well as she did, sheadded, "Nancy, I'm counting on you to obey me."

Suzy tucked her knees under her chin, wrapping her arms aroundher legs, and I put my arm across her shoulders. She wasn't pouting; itmade her sad to think about the poor polio children with their wizenedlimbs and squeaky little wheelchairs, their drawn curtains and dilatedeyes longing for outside. It terrified her and broke her heart whenever weheard of another child in our neighborhood tumbling into the bottomlesswell of his own little bed.

These days we've all but forgotten what a scourge it was, but in 1952,there was a global epidemic. "Infantile paralysis" was a malevolent phantomthat shadowed every summer day and haunted every cricket-fillednight, poised to cripple and kill with one touch to the spine, the mostdeeply dreaded childhood disease of the twentieth century worldwide.Mom stroked Suzy's strong shinbone.

"Right this minute, scientists are working to develop a vaccine," shesaid. "We have to do everything we can to help. Like this bake sale." Sheset a Tupperware container on the table. Through the milky-opaqueplastic, we could just make out mounds of pink-tinted frosting toppedwith maraschino cherries. "Every little cupcake will do its part to end theepidemic. The money helps the scientists, the scientists help physicians,and if lots more mothers and daughters collect lots more money, and thescientists keep working, someday, they'll be able to give people a shotand—" She snapped her fingers. "No more polio."

Of course, in the oppressive heat of that long, sequestered summer,this grand vision sounded as ridiculous to me and Suzy as a cure forbreast cancer sounds to all the naysayers presently telling me how impossiblethat is.

But in that first prosperous decade following World War II, the ideawas still fresh in the American mind that we could accomplish anythingwhen we all pulled together for the good of our nation. An entirely newform of media— television— swept the country faster and more infectiouslythan any virus, creating (or perhaps simply awakening) a scalybut soft hearted dragon, the mass audience, provoking awareness that aviable vaccine was agonizingly close. Mothers saw their children standingon knobby pony legs just this side of that tipping point, motherswho'd recently awakened to the idea that the hands of women— women'svoices, women's work— could build bombs as well as grow roses. In thatmoment, a singular need met its cultural match. Grassroots philanthropysprang up, money rushed forth, and before the clock ticked intothe sixties, a solution was discovered, a bridge was built between scienceand society, and the phantom was vanquished.

In the United States alone, 58,000 people were stricken with poliomyelitisin 1952. More than 3,000 died; another 21,000 were left disabled.

Jonas Salk's vaccine was licensed in 1955 and was being widely distributedby 1959. In 1962, there were fewer than 1,000 cases of polio reported.In 1963, there were fewer than 100. These days, polio is a quarter- pagesidebar in a history book.

Along the way, of course, skeptics in all their towering intellect persistentlypointed out the many reasons the virtual eradication of poliocould never be accomplished.

My mother respectfully disagreed, efficient and undeterred in herdaily purpose. Suzy and I were bundled into the family station wagonevery weekend to accompany Mom on her various missions. It wasn'tup for debate; it's what we did. I'm in the habit of saying Mom was a"tireless volunteer," but putting that on paper, I realize it's ridiculous. Ofcourse, she was tired. She must have been exhausted by all she did, butshe did it anyway, and without complaint, which makes her all the moreremarkable. In addition to her organized charity work, there were alwayslittle personal mercies: a casserole for someone just out of the hospital,a freshly folded laundry basket of diapers, the weeding of a flowerbed,whatever she could do to lighten a neighbor's load.

That summer she had to be careful. Rather than risk bringing thevirus into our home, she'd put together a basket of food and other necessitiesand leave them on the recipient's porch with a light tap on thefront door. The lady of the house would move the curtain aside and wave,waiting to open the door until Mommy was safely out on the sidewalk."Instead of dwelling on all the things you can't do," said Mother, "figureout what you can do. What you will do. My mother used to say, 'If youhave to ask what to do, get out of the kitchen.' I'll bet you girls could comeup with something if you put your heads together."

We piled into the station wagon and set out on our appointed rounds.Sweltering in the backseat, Suzy and I complained and deviled each otherlike a couple of spiny pill bugs.

"Girls, that's enough."

Mom sent a few ominous warnings over the transom as she negotiatedthe stop- and- go downtown traffi c, but Suzy and I kept at it until theold station wagon swung to the side of the street and lurched to a halt.Suzy and I rarely saw our mother's patience fail. Every once in a greatwhile, there might be a flare of angry words or a swift slam of the silverwaredrawer, but even that was as startling and incongruous as a griffinlanding on the Sunday dinner table.

Mother didn't raise her voice, but her tone crackled with aggravation.

"Out."

Suzy and I looked at each other, looked out at the unfamiliar neighborhood.Surely, she didn't mean—

"I said, out."

Our parents didn't believe in corporal punishment; Mother disciplinedby eye contact. We met her withering gaze in the rearview mirrorfor a tense Don't test me moment, then Suzy opened her door. Weshuffled out onto the curb, and I instinctively reached for Suzy's hand,knowing she'd take care of me now that we were on our own in the worldand would have to get jobs in factories or join the army or find a band ofnomads to camp out with.

Mother stood in front of us in the blazing sun, shielding her eyes withher hand.

"People have died for this country," she said. "People have sacrificedtheir lives so you could live in peace and freedom, and all that's asked ofyou is that you take care of it. Stewardship. That's all. You care enoughabout your community to look after those who aren't as fortunate asyou. When you see someone in need, you give. When you see somethingwrong, you fix it. Because this is your country, it's your community. Youcan't sit around on your duff waiting for someone else to make it better.It's up to you."

She shook her finger at us, genuinely angry. Suzy and I stared downat our Mary Janes, waiting for something we hadn't heard a thousandtimes.

"If you girls devoted half the energy you use complaining and bickeringto actually doing something for somebody else, I think you'd beamazed at what you can accomplish. So can I count on you? Are youwilling to be good stewards for your country?" asked Mother. "BecauseI'll tell you right now, you're not getting back in that car until I hear yousay it. Both of you."

"I'll be a good steward," Suzy responded immediately.

Mother cut her pointed gaze over to me, but I locked my arms in frontof my round little middle, sun prickling at the back of my neck. I'm five,I wanted to tell her. Big enough to know I wasn't big enough to do anythinghuge or meaningful or missionary. But there was no use arguing that angle with Ellie Goodman, Standard Bearer, Doer of Good, Righter of Wrongs, Mitzvah Maven.

Suzy jimmied me with her elbow and hissed, "Just say it so wecan go."

"I'll be a good steward," I said without budging the square set of myjaw.

Mother opened the car door. Suzy and I climbed in, thoroughlyabashed. Returning to the road before her, Mom steered back into thetraffic and proceeded with her errands, and we trooped dutifully, if notcheerfully, behind her. That night, as I lay thinking wistfully about coldhose water in a plastic pool, Suzy bounded onto my bed.

"Nanny! I know what we should do to be good stewards."

"What?" I yawned.

"Variety show." Suzy hatched her brilliant idea like a magician turninga pigeon out of a top hat. "A song-and-dance variety show and youcan sing and dance and I'll sell tickets. We'll get everybody to help."

It was an ambitious undertaking, but I had no doubt Suzy could rallyall the neighborhood children into cast and crew and sell tickets to allthe adults, because everyone loved Suzy and would pretty much giveher whatever she asked for. I could belt out all the words to "The SecretarySong." (Remember that great old Rosemary Clooney number withthe "bibidi boo bot" chorus?) Just in case, I fortified my stage presencewith a Donald Duck hat that actually quacked. A bit of the razzle-dazzle,I figured, to compensate for any vocal prowess that might be slightlylacking.

By noon the next day, all twenty-three children who lived in ourneighborhood were on board. Suzy and I were like a couple of Broadwayimpresarios, auditioning talent, casting acts, herding crew. Suzy hadmost of the roughneck little boys corralled with her irresistible smile,and I strong-armed the stragglers. A grand theater was jury-rigged, employingthe side of our garage as a backdrop. Something right out of aMickey Rooney movie. Suzy went out and sold sixty-four tickets. Thatevening, friends and neighbors gathered on the lawn with folding chairsand picnic blankets.

I can't begin to remember what was on the program. Some of thekids were genuinely talented, but there were a few painfully unpracticedperformances on school band instruments, I suppose, maybe a mangledmagic trick or two, a few fruits of tap and ballet class, some cheerleadingand gymnastics, but of course, the whole program was inherentlyadorable because our appreciative audience was composed of people whoadored us. I trotted out for my Rosemary Clooney number and deliveredthat thing like a wrecking ball.

Understand that I was a chubby little girl— and not endearinglychubby like Darla in The Little Rascals. More of an ungainly chubby.Like Chubby in The Little Rascals. But I'd never been made to feelself-conscious about it, so when the time came, I put myself out there,completely confident, uninhibited, the way consistently loved childrennaturally are. (How I wish I could go back and bottle a little of thatchutzpah for my grown-up self.) Thinking back to that moment, it's plainto see that the first thing Mom did to prepare me and my sister for a lifeof service was to nurture in us a sense of self-worth. The very first steptoward giving to others is grateful recognition of our own assets.

They say you're happiest doing what you did as a child, and those were the moments I remember most: when Suzy and I were fully engaged, performing— not in the sense of putting on a show to generate applause— performing in the sense of doing. Performing an act of kindness— or an act of will. Generating a response. I probably could havebeen a good theater producer.

"If there's a dog that needs biting," Daddy used to say, "Nancy's theone to bite it."

I've always excelled at backstage cat-herding and organization, butI'm a pretty good entertainer, too, and you have to entertain people atleast a little if you want them truly on your side. Suzy was the visual artist.She understood the dynamics of drama and spectacle, what it takesto sweep people in and make them fall in love with an idea, a place, ora cause. In retrospect, I understand how moving it must have been forthese terrified parents to see their healthy children dance. Our neighborhoodvariety show was a resounding success. There was no lack of applausefor the Clooney number, but my "bibidi boo bot" may have beena little off , because the next day, Suzy tactfully suggested, "Next time,Nanny, it might be better if I sing and you sell tickets."

Mother drove us to St. Francis Hospital on Glen Oak Avenue. Elated,Suzy and I marched to the administrative desk in the front lobby andpresented the receptionist with a crisp white envelope containing $50.14in pure polio-killing, spine-saving, all-American do-gooding cash. Afew days later we got a thank- you note from Sister Walburga, the hospitalsuperintendent, assuring us the money would be "put to very goodadvantage."

Nuts and bolts. Dollars and cents. Cause and effect. The lesson wasn'tlost on Suzy or me. This is where the rubber meets the road, I realized.

This is where will meets way.

A fundraiser is born.

So began Suzy's and my charitable life together. It was my earliestinkling of what goes into the chemistry of change: moment meets messenger,information becomes action. Hearts and minds shift to a newparadigm, money happens, and it all comes together.

A Brief History of the BeastThe earliest documented cases of breast cancer appear in the EdwinSmith Papyrus, one of several existing papyri that detail ancient Egyptianmedical practices. The unknown physician who crafted this documentdescribed a number of ailments and injuries and how they shouldbe treated with surgery, magic, or medicinal herbs. Warm tumors in thebreast were likely the result of an infection. The remedy: cauterization. Ashuddering thought, but the patient probably lived to tell about it. In thecase of hard, cold tumors deep within the breast, the scroll states simply,"There is no treatment."

This wasn't a disease the Egyptian physician saw often. Malignanttumors of all kinds were noted with about the same frequency in mostof the same gender and age demographics that apply today. Since he recognizedthat breast tumors varied in nature, it's possible this physician may have also observed that those presenting in younger women tended to kill with a swift , unstoppable virulence. But breast cancer is far more prevalent in women over fi ft y, and most women in ancient Egypt didn't live past thirty- five, so this patient was rare.

One woman in thousands.

Given what we know about this disease and about ancient Egyptianculture, I imagine One Woman watched with interest as the physiciancarefully recorded her case. She almost certainly didn't know how toread or write. There is no treatment, he told her, straightforward but notwithout compassion, I think. He seems like a "good doctor" sort in hisother writings. Perhaps he offered her a tincture made from alcohol andflowers, a prayer, a little stone god, some comfort she could cling to.One Woman went home to her family and went on with her life. Thetumor in her breast grew steadily over the coming months. The breast itselfseemed larger, the skin thick and red, spidered with veins and stretchmarks, but she felt strong and went about her daily business. Some dayswere better than others, and she felt a flash of hope. She laid fruit in frontof the little stone god, whispered in its ear. Then came another day, andher hope faded.

The cancer metastasized, spreading from breast to breast, then riddlinglymph nodes, lungs, spine, and liver. First, she felt a firm bulgeunder her right arm. Her fingers tingled and burned with neuralgia. Shedropped things sometimes. Then there was a stabbing pain in her spinewhen she bent to lift her small child. Eventually, she had to sit on thefloor and let him climb into her lap, holding him over on the side whereshe could still stand the pain if he leaned against her breast. When shelaughed or yawned, there was a stitching pull deep inside her chest. Itseemed to form a tight fist in her lung at times. She'd wake up coughing,struggling for breath. It made the baby cry, but when she tried to go tohim, she was dizzy and nauseous. She was bent with the effort of gettingup in the morning. Her complexion yellowed. The coughing spellssettled into a nagging pattern of hoarse, painful barking.

Under her linen dress, her breasts were visibly misshapen and distendednow. When she was naked, she could see a shadow rising to thesurface. The skin became translucent purple and gradually gave waylike a slit in a temple curtain. The lesions wept a thin blackish-bloodyfluid. The skin crusted and opened, an unblinking eye with the slick,eel-colored tumor at its center. Her sisters tried to clean and care forher, but on a cellular level, the tumors were dying as rapidly as theymultiplied, so the bulging tissue became necrotic, and the smell ofdeath hung in the air, permeating the bedclothes, lingering in her hair.The woman's strength leaked out of her. Loved ones tried to feed herbroth and soft meal cakes, but she was quickly wasting away, barely athread of herself.

At the end, her sisters sat next to the bed, whispering to each other. Isshe breathing? Did you see her eyelids flicker? They were terrified to touchher now. What if this dark disease was contagious? They had to think oftheir children. Lying in bed at night, they moved their hands over theirown breasts, afraid to exhale. Here? Didn't she say it started here, with abump like a small pebble?

It would be nice to think someone who loved her held her whenshe died.

A thousand years went by.

Four centuries before the birth of Jesus— about the time Siddharthabecame the Buddha and Malachi the last of the Hebrew prophets— theGreek scientist Hippocrates observed coal-black tumors erupting throughthe skin of his patients and concluded that the malady was a manifestationof too much black bile or melanchole in a woman overly influencedby the element of earth, an internalization of autumn's dry cold. Tentacledtumors examined during autopsies spidered into the body, evokingthe image of a crab.

Karkinos.

Cancer.

There was no hope of treatment or cure, so it was better, Hippocrateshypothesized, to prolong the life of the afflicted by making her as comfortableas possible in all other respects. He discouraged his studentsfrom surgically excising tumors from their patients' breasts, based on hisassumption that pervasive black bile was a systemic problem. Barring interventionby the gods, the disease would invariably return with swiftly killing insistence.

For two thousand years, his conclusions remained the conventionalwisdom. There was a glimmer in 200 c.e. when Galen, a devoted followerand biographer of Hippocrates, recorded his observation that not all breasttumors were created equal; some were slow and insidious, others quickand virulent. Not all had the iconic crab legs; some blossomed deep in thebosom and remained isolated from surrounding tissue like a lily floatingin a pond. Galen treated patients with opium, licorice, castor oil, and incantations,but ultimately, he confirmed the six-hundred- year-old findingsof Hippocrates: Breast cancer was a systemic disease caused by the darkesthumor, surgery was contraindicated, sufferers were doomed. This remainedthe final word on breast cancer for another fifteen centuries.

Roughly around the time of the American Revolution, in an effortto discredit the time- honored ideas of humoral medicine, French physi-cian Jean Astruc placed a slice of a breast cancer tumor in the oven nextto a slice of beef, cooked both to a jerkylike consistency, chewed eachone thoroughly, and declared that they tasted exactly the same, proving(among other things I can't even bear to joke about) that the breast cancertumor contained neither bile nor acid.

Out with the old superstitions; in with empirical state- of- the- artmethods. Now the true cause of breast cancer was wide open for speculation.One school of thought pointed to the high incidence of breast canceramong nuns as evidence that breast cancer was caused by a lack of sex.

Because breasts are sexual organs, n'est- ce pas? Without the fulfillmentof their bountifully natural purpose, what could they do but atrophy andbecame cancerous? (I imagine there was no shortage of selfless lads willingto hurl themselves between innocent young women and this dreadeddisease.) In women who did voluntarily engage in "relations"—randywives and scurrilous hookers— tumors were said to arise from a lymphaticblockage caused by an overly vigorous libido. Another popular theory cited constriction of lymphatic vessels due to depression. Others blamed the curdling of unexpressed milk and the coagulation of blood caused by a sedentary lifestyle.

And so, in the enlightened age of Mozart, after three thousand yearsof observation and experimentation, it was scientifically deduced that ifa woman presented with breast cancer, it was due to frigidity, promiscuity,craziness, laziness, or all of the above in some combination with theunknowable will of God.

One Woman after Another passed into ancient history, each less thana grain of sand, and there are places in the world where nothing haschanged. Today women in developing countries echo the story of thewoman in the papyrus and face their fate as if the last three thousandyears never happened. I've seen One Woman's face, and I can't forget her.Sitting on a wooden stool by an ancient stone wall, wearing clothes rightout of a Cecil B. DeMille Bible epic, she looked up at me and asked, "Thisdisease— is it contagious?"

She has to think of her children.

At this writing, according to statistics, breast cancer is the leading cause of cancer death for American women between forty and fift y- five years ofage. In One Woman's corner of the world, there are no statistics, nevermind screening or even the possibility of treatment. Breast cancer comesand goes unnoted, misunderstood, taking thousands of lives with it.One Woman at a time.