Melba Newsome

It might seem reasonable that with carbon-copy DNA they would all get the same disease, but that's not necessarily the case. "Genetics aren't the entire story," says Mark H. Greene, MD, chief of the clinical genetics branch in the division of cancer epidemiology and genetics at the National Cancer Institute (NCI). "For twins the risk is perhaps four times greater, but it is by no means a certainty that if one twin gets breast cancer, the other is destined to get it, too."

When I tell him that all the quads were diagnosed with breast cancer, he is momentarily speechless. "That's extraordinary," he says. "It's also extremely unlucky. It seems like there was something else going on in their lives. Could there have been some common environmental exposure they received that might explain it?"

Catherine has a theory: "It was all those shots," she says angrily. "Those shots gave us cancer."
. . .
Today the basement of Annie Penn Hospital houses the cafeteria and medical records staff. In 1946 it was the only place black patients were allowed. Annie Mae, 37, and her 55-year-old husband, James "Pete" Fultz, were tobacco share-croppers who already had six children, all of them born at home. This time Annie Mae grew so large that local doctor Fred Klenner, MD, ordered X-rays (the technology available at the time), which determined that she was carrying triplets. A bout of spinal meningitis at age 2 had rendered her deaf and mute, and Klenner considered the pregnancy to be so high risk that he insisted she check into the hospital two weeks before her due date. On May 23, between 1:15 and 1:30 A.M., Klenner delivered the three babies he expected--and one he didn't.

"They had no idea I was there because I was hiding behind Alice's back," says Catherine with a laugh.

Margaret Ware, the nurse assisting Klenner with the birth, says everybody in the hospital came to help, and recalls, "We were overrun by newspaper and radio reporters." Identical quadruplets weighing less than four pounds each, the Fultz newborns immediately became national news. At a small country hospital with no state-of-the-art equipment, they might not have survived were it not for Klenner's zealous resolve. "Dr. Klenner did all he could to save those babies," says Ware, "and he did."

The tiny girls were wrapped in cotton, placed side by side, and kept warm with hot-water bottles. Klenner also instructed the nurses to feed them with medicine droppers. He insisted, though, that massive doses of vitamin C were the real reason the quads made it. After successfully treating his wife's bleeding gums with vitamin C several years earlier, Klenner had begun to research his hunch that ascorbic acid could cure everything from the flu to polio--a view that later caused him to be frequently mentioned in the same breath as noted scientist Linus Pauling. "These babies were started on 50 milligrams of ascorbic acid the first day and, of course, this was increased as time went on," he wrote 25 years later in the Journal of Applied Nutrition.
. . .
In May 1990, Ann, Alice, Louise, and Catherine gathered at the Reidsville Garden Center for a 44th-birthday party. It was as if they knew they didn't have much time left together. A few months later, Catherine went in for a routine checkup, and the doctor found a lump in her breast. A biopsy determined that the cyst was cancerous. The diagnosis was a shock but not a surprise. Ann had just been diagnosed with breast cancer, Louise had received the news a few months before, and Alice had undergone a mastectomy a decade earlier.

Within a year, Catherine began burying her sisters, starting with Louise. Ann died in early 1997, and in late 2001 it became evident that Alice, who had never married, was losing her 20-year battle with the disease. With cancer in every part of her body, she waited out her days in Annie Penn Hospital, the very place she'd been born. "She kept saying to me over and over. 'Find my son. Find my son,'" Catherine recalls through tears. "Her eyes went to the door every time it opened, hoping he would walk in the room."

There’s a saying about breast cancer: Genetics loads the gun and environment pulls the trigger. If that's true, what was the environmental catalyst that pulled the trigger on a loaded revolver aimed at the Fultz quadruplets? There are no known cancer clusters in North Carolina, and, to their knowledge, the sisters were never exposed to excessive radiation. That's why I keep coming back to those shots.

"I'm not aware of any evidence that high doses of vitamin C might increase the risk of breast cancer," says Mark Greene of the NCI. "It's conceivable that they were unaware of what was really in those concoctions."

The truth is, nobody did know. Klenner's belief in vitamin C eventually led him to experiment with B vitamins, which he claimed could cure multiple sclerosis. But no one was overseeing his work, leaving him free to use whatever he wanted. He did, it turns out, give up his hospital privileges at Annie Penn Hospital after a dispute over controversial practices.

Without having examined the quads or their records, Harold P. Freeman, MD, director of the Center to Reduce Cancer Health Disparities at the National Cancer Institute, thinks that in their case, genetics was the culprit. It's estimated that between 5 and 10 percent of breast cancer is hereditary, largely caused by mutations in the BRCA 1 and BRCA 2 genes. (None of the quads, including Catherine were ever tested.) "Up to 80 percent of those who have that genetic mutation will, in time, develop breast cancer, and the Fultzes' genetic makeup is the same because they're identical," says Freeman. "But there also seems to be something running through that family."

Genes, shots, carcinogens in the environment--whatever the cause, it's true that of Catherine's ten siblings, eight are dead, several of them of various kinds of cancer. Every time her hand strays to the place where her breast used to be, she is reminded of what the disease can do. And every time she thinks of her 27-year-old daughter, she is afraid of what it might do again.

"I know she's scared," says Catherine, holding a picture of Tasha.