Written by: Christine G. Adamo
Reviewed by: Dr. Richard Baxter
While you may have tested positive for BRCA1, BRCA2 or related breast cancer genes, there’s no need to be disheartened. In fact, you have every reason to be hopeful. Women who are tested early are able to take preventive measures to address their breast cancer needs.
Actress Christina Applegate found out she was susceptible to – and, in fact, had – breast cancer at the age of 36. Despite a frenzy of publicity and protests from breast implants activists, she opted to undergo bilateral prophylactic mastectomy accompanied by breast reconstruction with breast implants. Read on to find out why.
You, too, are in a unique position to manage your relationship with breast cancer and, quite possibly, avoid it altogether – through skin and nipple sparing mastectomy followed by breast reconstruction using breast implants or other means. Educate yourself now and minimize the future impact breast cancer and/or breast cancer surgery has on your body and mind.
By knowing what your options are – and how they differ – you’ll be able to pursue a plan that’s right for you. Begin identifying a course of action that suits your physical and emotional needs today!
How Positive BRCA Test Results Benefit You
While receiving a positive result for BRCA1 or BRCA2 may not sound like a benefit, it certainly is. BRCA1 and BRCA2 testing for genetic mutations related to breast cancer has become fairly common in recent years. Testing for susceptibility to breast and/or ovarian cancer is an early detection measure that helps identify your level of personal risk which aids in:
- Prevention – to stave off the development of breast cancer
- Monitoring – so you can take measures to safeguard your health
- Avoidance – to minimize your overall cancer risk
Testing also reduces the tension caused by uncertainty. Results guide medical professionals who can then construct a thoughtful plan related to your own screening and treatment, which may include: checkups, other forms of testing and surgery. It helps you make informed decisions about your future and reduce your cancer risk while maintaining your dignity.
Options for BRCA Positive Patients
If your body’s own tumor suppressors are not functioning properly, rest assured that you do have options. Once you know what you’re dealing with, deciding on a course of prevention and treatment becomes easier. You can plan ahead with a positive attitude, prioritize your own well-being, and take any steps necessary to enjoy a long and fulfilling life.
According to the National Cancer Institute at the National Institutes of Health, several options exist for managing your BRCA1 or BRCA2 related breast cancer risk. They include:
- Prophylactic Mastectomy or Surgery
- Chemoprevention
- Risk Avoidance
- Screening
An overview of each option follows and is based, in part, on information provided by the NCI.
Prophylactic Mastectomy or Surgery
In 2008, Actress Christina Applegate appeared on “Good Morning America” to explain her choice of prophylactic double mastectomy. As she told GMA Anchor Robin Roberts she had tested positive for the BRCA1 gene and was found to have cancerous lumps in one of her breasts just one month prior. Yet, on the set, she beamed.
“I'm clear. Absolutely 100 percent clear and clean," Christina said. “It did not spread – they got everything out, so I'm definitely not going to die from breast cancer…and, you know, I'm going to have cute boobs ‘til I’m 90.”
After reviewing the available treatment plans, Christina explained: “…the only one that seemed the most logical and the one that was going to work for me was to have a bilateral mastectomy.”
She opted out of long-term radiation and chemotherapy treatment – citing her mother’s own struggle with mastectomy followed by chemotherapy and a hysterectomy as incentive to take a new approach. That approach (prophylactic surgery) involves removing as much at-risk tissue possible to reduce the chance of developing cancer.
In a bilateral prophylactic mastectomy, both affected and healthy tissue is removed from the left and right breasts. This can be done in a way that preserves your skin, nipple and areola. The procedure is followed by breast reconstruction using breast implants for a balanced, symmetrical outcome. While prophylactic surgery does not guarantee against the development of cancer, it is one option for you to consider.
Other, related surgery includes prophylactic salpingo-oophorectomy – the removal of healthy fallopian tubes and ovaries – to curtail estrogen production which has been found to increase breast cancer risk.
Chemoprevention
Chemoprevention involves the use of natural or synthetic substances to reduce the risk of cancer development or recurrence. While the NCI cites anti-estrogen drugs like tamoxifen as being shown effective at reducing the risk of developing breast cancer by 50% and reducing recurrence rates in women undergoing treatment for a previously diagnosed breast tumor, side effects exist.
The FDA has approved the use of tamoxifen as a breast cancer treatment which wards off cancer development in premenopausal and postmenopausal women at risk for the disease by inhibiting hormone-related breast cancer cell growth. However, few studies have evaluated its effectiveness in women with BRCA1 or BRCA2 mutations.
In an NCI-sponsored clinical trial, the drug raloxifene was shown to reduce the risk of developing invasive breast cancer in postmenopausal women at increased risk for breast cancer – with results similar to tamoxifen. Raloxifene was then approved by the FDA for breast cancer risk reduction in postmenopausal women. Like tamoxifen, however, evidence was not found as to whether women with BRCA1 and BRCA2 mutations benefit from its use.
Risk Avoidance
Just as your level of cancer risk is unique, the methods used to reduce your risk are also unique. Factors found to effect the development of breast and ovarian cancers in general populations (BRCA1 and BRCA2 positive and negative) include:
- Age – with breast and ovarian cancer occurring more often in women 50+
- Personal Medical History – with a prior history of cancer related to recurrence rates
- Family Medical History – with close relative diagnosis indicating higher personal risk
- Hormone Levels and Therapies – with estrogen and progestin linked to breast cancer
- Other – Obesity, Physical Activity Levels, Alcohol Intake & Dietary Fat Intake
Screening
Screening or surveillance can provide early detection of cancerous tissue and cells so that they can be treated quickly and less invasively. Breast cancer screening methods include mammography, clinical breast examination and MRI (magnetic resonance imaging). Ovarian cancer screening methods include transvaginal ultrasound, blood test and clinical examination.
While screening does not guard against cancer, it can help identify it and inform treatment. It is often recommended that BRCA1 and BRCA2 positive women participate in high-risk observation and management programs in which they obtain radiological breast scans (in lieu of mammograms). These provide a more thorough assessment of cell-tissue content, but can be highly expensive and cost-prohibitive if not covered by insurance.
Christina Applegate, in fact, explained to GMA that her own cancer was detected by MRI which was quickly followed by a biopsy. Christina felt so strongly about the benefits of using MRIs to detect cancer cells prior to tumor formation that she launched a foundation to assist women who could not cover their cost – high-risk women “who (have) had breast cancer in their family or are gene positive for the BRCA1 gene that is linked to breast cancer.”
Interested in learning more about prophylactic mastectomy and breast reconstruction with breast implants, chemoprevention, risk avoidance and surveillance techniques? Discuss your options with a qualified, board-certified professional who understands your needs and offers the best level of care.