October is breast cancer awareness month. In my family, we’re very aware. My sister had a mastectomy last Tuesday.

One of my close friends, who had a double mastectomy last winter, told me she’d recently been with a group of women in Washington and none of them had had a mammogram in the last year. Why not? They were busy, they forgot, they had one the year before, they didn’t want to think about it. All but one were over 40. Then again, my friend had been religious about her annual checkups, and she was the one with breast cancer. Life’s not fair.

We women need to take responsibility. We need to do our self-exams, remember our annual checkups, and demand insurance coverage, research funds and free mammograms for women who can’t afford them. We need to encourage younger women, who fall outside the official guidelines for mammograms, to be aware that when breast cancer strikes young women, it tends to be particularly aggressive and ruthless. So younger women have to be aggressive and ruthless about being screened, tested and reimbursed by their insurance companies for the procedures.

But there is only so much we can do as individuals.

What should we do if we happen to be born into families that are cancer-prone?

What do we do about doctors who let us down and then look to other doctors and insurance companies to paper over their negligence?

My sister had cancer 23 years ago. It was non-Hodgkin’s lymphoma. It showed up as a lump in her breast. She had the lump removed, radiation of her breast and heavy-duty chemotherapy. It was hellish, but it saved her life. On the other hand, it was an experience she had no desire to relive.

So she’s been careful. Over the years, she’s had biopsies, MRI’s, scans and blood work; she’s been cautious not crazed; she has lived with the sword over her head and a smile on her face. I’m the one who worries about everything. She does what she has to do and doesn’t dwell on it.

Two years ago, when she found a lump in her breast, the same breast that had been radiated 20 years ago, she went to the man who was supposed to be the top breast surgeon in her area of Pennsylvania. He ordered an MRI and, after reviewing it, told her not to worry about it, that it was nothing with nothing.

Nothing with nothing. Nothing to worry about. Except he was wrong.

A month ago, she felt the lump again. It felt different. Bigger. Tender. She went back to the famous breast surgeon. Nothing with nothing, he reminded her. We tested that two years ago.

I want it out, she said. He did a needle biopsy. It was “inconclusive.” He scheduled a lumpectomy. We met in New York for dinner the weekend before. I woke up the next morning with my hands aching. I’d been clenching my fists all night. I had a bad feeling. And I was starting to get mad at Dr. Nothing with Nothing.

Why would you let a lump sit there for two years, in a breast that’s been radiated, with a woman who went into menopause in her 30s and had been prescribed hormones ever since? Why didn’t her doctor do what mine does when he finds lumps – order follow-up MRI’s at six-month intervals to see if there’s been a change? Who was he working for: her insurance company, or her?

But of course I didn’t say those things to my sister. I said them to one of my best friends, who lost her sister to breast cancer, who talks me down when I insist on seeing disaster around every curve.

When I got three messages from my sister two days after the lumpectomy and none of them said everything was fine, I knew Dr. Nothing with Nothing was worth just that. It may have been nothing two years ago, but it was something now.

The margins weren’t clean from the lumpectomy. The breast tissue was compromised from the radiation in the ’80s. So there was no question about the next step. The only issue was whether it was in the lymph nodes, as well. We’re waiting on that. Dr. Nothing with Nothing said he saw some abnormal cells in the sentinel node and took a few more to test. Not a good sign. Why is he doing the surgery, I asked. He’s supposed to be the best. I wonder if that’s what a jury will think.

I had a friend named Copelia who died because of a doctor like my sister’s. She belonged to an HMO, so she didn’t have too many choices. She found a lump, too. Her doctor didn’t order any fancy tests. He didn’t do a needle biopsy. He said he could tell from the mammogram that it was nothing with nothing. Every time I saw her, she would ask me what I thought about her lump. I’m a lawyer not a doctor, I used to say. After two years, she finally went to a different doctor. Nothing with nothing was stage-3 breast cancer.

I couldn’t find a lawyer who would take her case. I went with her to the meetings. The lawyers explained that there wasn’t much money in the case because she’d signed an arbitration agreement without knowing it, that it wouldn’t be easy to prove things would be different if the cancer had been diagnosed earlier, that the HMO would probably delay everything to see how it turned out. If she survived, they’d say there was no injury. If she died, they’d claim it was inevitable. As it turned out, she died.

Hopefully, my sister will do better. And maybe we’ll even get to teach something to her Dr. Nothing with Nothing. For her sake, and Copelia’s, and the rest of us.

Susan Estrich is a syndicated columnist and author.

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