Hollywood superstars Angelina Jolie and Christina Applegate both opted to have heir breasts removed. In an op-ed in the New York Times, the cancer-free Jolie revealed she did so when her doctors deemed her to be at a high risk for breast cancer because her mother had died of the disease at age 56 and she carried the BRCA1 gene — a predictor of the disease. Applegate, on the other hand, had been diagnosed with cancer in her left breast and, as she revealed on the “The Oprah Winfrey Show” in 2008, for her, the right choice was foregoing radiation treatments and having a bilateral mastectomy so she wouldn’t have to worry about the cancer appearing in her other breast.
“It came on really fast. It was one of those things that I woke up and it felt so right,” Applegate said. “It just seemed like, ‘I don’t want to have to deal with this again. I don’t want to keep putting that stuff in my body. I just want to be done with this.’ And I was just going to let them go.”
If faced with the same dilemma, what would you do?
Chances are, your gut reaction would be, “take ’em both off.” That’s a completely understandable thought if you know that many women in your family have had breast cancer, and your doctor’s analysis — based on family and medical history — places your risk level squarely above 20 percent. Knowing there’s a high likelihood you will develop breast cancer can be scary and overwhelming. Preventive surgery — otherwise known as prophylactic mastectomy — can seem like a reassuring solution.
Yet the decision to go ahead with such a major procedure is far from easy. As I show in my novel, “Bedside Manners,” these decisions can be costly. Removing your breasts is both physically and emotionally strenuous — not to mention irreversible and life-altering.
As a breast-imaging specialist, I often have discussions with women about their breast-cancer risk and what they can do about it. With so much information out there, the options can be confusing and difficult to sort through. Prophylactic mastectomy is one choice, but it may not be the right one for everyone. If you are not ready to take this step, there are still many powerful screening options that will allow you to be proactive about finding any potential changes that may signal it’s time to take action.
Annual screening mammography
This is by far the best way to make sure your breasts remain healthy and cancer free. Mammography is the only test that has been proven to save lives. If your center offers 3D mammography, also known as tomosynthesis, you should definitely choose this option. This newer type of mammogram is better at finding subtle cancers and also decreases the number of women who need to return for additional pictures.
There are several other tests that can be used for supplemental screening in conjunction with your mammogram. By far the best additional test for high-risk women is breast MRI. This test is extremely sensitive — it finds nearly all cancers when they are small and treatable. Screening breast ultrasound, another test used for supplemental screening, is not as useful as breast MRI — it finds fewer cancers and requires many more benign biopsies to diagnose these cancers. Other screening tests such as breast-specific gamma imaging are less commonly used.
Develop a relationship with a breast specialist
Some large centers offer high-risk clinics, but in most parts of the country, this will mean making an appointment with a breast surgeon. This doctor will go over your history and help you develop a screening regimen that works for you. Some women prefer to have their mammogram and breast MRI performed on the same day. Others choose to stagger these tests every six months, so they are being screened at least twice a year. Your breast surgeon will also examine your breasts on a regular basis to assess for subtle changes.
Medication
There are also several medications that can help you stay cancer free. Taking medicine to decrease your risk is known as “chemoprevention.” These medicines have been shown to decrease your chances of getting breast cancer, but they also can cause side effects such as hot flashes and blood clots. Set up a meeting with an oncologist to discuss the pros and cons to help you decide whether chemoprevention is right for you.
Know your own breasts
The medical professionals are certainly important, but you are the ultimate expert on your body. If you notice something feels or looks different — a lump, an area of thickening, nipple discharge — let your doctor know immediately. Also, set a time to examine your breasts at least once a month and call your doctor if you notice any changes.
It’s also important to know that women who are considered high risk can have widely different chances of developing breast cancer. Women with known BRCA-positive gene mutations have been shown to have up to 72 percent risk of receiving a breast cancer diagnosis by age 80, according to a 2017 report by the National Cancer Institute, while other “high risk” women have closer to the 20 percent lifetime risk. Your level of risk will factor into your discussion with your doctor and help you come up with a plan to move forward with this new information.
You can do this. It’s always better to be educated and informed than bury your head in the sand. Congratulations on taking control of the situation and being proactive about your breast health.
Heather Frimmer’s debut novel, “Bedside Manners,” will be published by SparkPress in October. To find out more, visit www.heath
