Preventative Cancer Measures: How To Make Decisions
- 99.1 The MIX host Elizabeth Kay, of Milwaukee, Wisconsin, decided to have a preventative double mastectomy (the removal of both breasts) after finding out her family carried the BRCA2 gene mutation – which means she has a higher risk of developing breast cancer.
- BRCA is comprised of two genes BRCA1 and BRCA2, which work as tumor suppressors. When either of these genes is altered, damaged DNA cannot be repaired properly, leading to an increased risk of breast and ovarian cancers.
- There are several different genetic tests available to find out if you have the BRCA1 or BRCA2 (the one Kay’s family has) gene mutation.
- A double mastectomy is a procedure in which both breasts are removed to get rid of cancer. The procedure may also be performed as a preventative measure for women who are at a very high risk of developing breast cancer.
The 41-year-old host of the 99.1 The MIX opened up to WISN12News before her Tuesday surgery in hopes to spread breast cancer awareness and inspire others to be proactive about their health.
Kay recounted doctors informing her that her risk for breast cancer was 58%, something she dubbed “worse than flipping a coin.”
The odds left her with some important decisions to make, to either get screenings every six months, take an endocrine pill throughout the next five years, or get a preventative double mastectomy.
She continued, “I have decided to go ahead and take these preventative measures similar to what Angelina Jolie has done, and have a bilateral mastectomy.
“Then I’ll have reconstructive surgery, and then I will also have my ovaries and fallopian tubes removed.
“This is serious. It’s in my family and I am being proactive. I don’t want any part of cancer. And if I can be preventative and I have this information, I’m going to do something with it.”
Expert Mastectomy Resources
Kay, who previously donated a kidney in a life-saving effort for her mother-in-law Camille Hamme, is grateful for being able to take preventative measures for her heath and her openness about it has inspired other women to get mammograms and check for cancer.
RELATED: Risk Factors for Breast Cancer
“They’re telling me that they’re going to also look into their family medical history and possibly get genetic testing. I love hearing that,” Kay added. “But go in and ask questions. Don’t be afraid of this knowledge. This knowledge could save your life.”
Kay also took to Instagram and TikTok on Monday to share all the fun activities she took part in the days leading up to her surgery.
She captioned the post, “I'm BRCA2 positive and I'm taking matters into my own hands so I can continue to live this incredible life! Tomorrow morning is my surgery! Thank you for your kind words and your support!”
Kay even shared a photo of herself on her Instagram story before her surgery, writing, “Let’s do this!”
@ekradio I’m BRCA 2 positive and I’m taking matters into my own hands so I can continue to live my best life! 👊🏼 #brca2positive #brca2awareness #brca2 #breastcancersucks
BRCA Gene Mutations and Breast Cancer
In understanding the role BRCA gene mutations play in breast cancer risk, it's crucial to know what these gene mutations actually are.
For starters, BRCA is two genes (BRCA1 and BRCA2). According to the National Cancer Institute, BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) are genes that produce proteins that work to repair damaged DNA.
The BRCA genes are sometimes referred to as tumor suppressor genes since changes, or mutations, in these genes can lead to cancer.
Everyone is born with two copies of each of the BRCA genes one inherited from each parent. If either parent carries a BRCA gene mutation, there's a 50-50 chance the child will carry it as well.
When BRCA1 or BRCA2 have certain mutations, or changes, men and women are at a higher risk level for several cancers, most notably breast and ovarian cancer in women.
According to the National Cancer Institute, 55 to 72 percent of women who inherit a harmful BRCA1 variant will get breast cancer by the time they reach 70 to 80 years old. Similarly, 45 to 69 percent of women who inherit a harmful BRCA2 variant will get breast cancer by that same age.
The percentage of women in the general population who will get breast cancer in their lifetime? About 13 percent.
“If a woman has one of these mutations the genetic BRCA1 and (BRCA)2 mutations, it puts her at basically the highest quantifiable risk for getting breast cancer,” Dr. Elisa Port, a surgical oncologist at Mount Sinai, told SurvivorNet. "We typically say between the 60 (percent) and 80 percent range."
When Cancer Runs in the Family: Survivor Amy Armstrong On The Importance of Genetic Testing
If you have a family history of cancer, like Elizabeth Kay, genetic testing could be one way for you to find out if you have harmful genetic mutations that increase your risk of developing certain cancers. Ask your doctor if genetic testing is right for you.
Dr. Port explained, “We now feel that casting a wider net with genetic testing is probably very prudent because finding out that one has a cancer predisposition gene can definitely change their course, their risk for cancer and what they might want to do about it.”
When to Consider Preventative Surgery for Breast Cancer If You Have a BRCA Mutation
People who have a family history of breast or ovarian cancer may want genetic testing, especially if they have one or more relative(s) who received their diagnosis before age 50. But what do you do if you are at an increased risk for breast cancer because of BRCA mutations?
Dr. Freya Schnabel, the director of breast surgery at NYU Langone Medical Center, says there are three options.
“The first option is intensive surveillance,” Dr. Schnabel told SurvivorNet in an earlier interview. “And this is an option that focuses on early detection of disease if it should occur.”
The second option comes in the form of medication to lower the risk of getting breast cancer.
“Tamoxifen is the one we use in young women, and then aromatase inhibitors can also be used in post-menopausal women, that have been associated with lowered risk for developing hormone sensitive breast cancer,” Dr. Schnabel said.
“So these medications have to be taken for five years, but have a meaningful reduction in the risk of developing breast cancer, especially for BRCA2 carriers.”
Is a Preventative Mastectomy Right for Me?
Prophylactic (preventative) surgery is the third option. “This is the option that will lower a woman's risk of getting breast cancer as low as we can get it, because the strategy here is to do surgery to remove the breast tissue as completely as we can,” Dr. Schnabel explained.
She continued, “When these operations are done prophylactically, certainly, no muscles are removed. And, in addition, there is no necessity to remove any lymph nodes, so that we take away some of the side effects and risks that are associated with that piece of the surgery.
"By newer surgical techniques, patients having prophylactic mastectomies will frequently have the option for having the surgery done in a way that preserves the nipple and areola.”
According to Dr. Elisa Port, preventative mastectomies are “really quite effective if done thoroughly.” She says they reduce the risk of developing breast cancer from the highest risk level of 80 to 90% down to the lowest risk level of 1 or 2%.
That being said, there are risks to consider.
According to the Cleveland Clinic, a prophylactic mastectomy has the risk of bleeding, infection, loss of sensation in the breast and dissatisfaction with your appearance post-surgery.
RELATED: What Are the Options if You Have a High Risk of Developing Breast Cancer?
Because of this, it's important to weigh the benefits with the risks with your doctor. If you discover you have a BRCA gene mutation, your doctor can help you understand your unique circumstances and what options may be best for you.
Is a Preventative Mastectomy Right for Me?
A prophylactic, or preventative, mastectomy is an operation where breast tissue is removed to prevent cancer from developing in the future. Typically, these procedures are performed on people who have an extremely high risk of developing breast cancer.
“Risk reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer … for genetic mutation carriers, who are the ones at the highest risk, there's unfortunately only one way to actually prevent breast cancer,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet.
A mutation in the BRCA1 or BRCA2 gene can increase a woman's risk of developing both breast and ovarian cancer. These genes can be passed down through families. If you find out you do have a mutation, it's important to speak to your doctor about options.
"Women who are found to test positive for a genetic mutation really have two options," Dr. Port explains. "One is what's called high-risk surveillance, which means we check them every six months or so mammograms, MRIs with the hope that if, God forbid, they develop breast cancer, we pick it up early. But that's not prevention, that's early detection.
"Early detection is a goal, it's not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk and that is the breast tissue," she adds.
The benefits of a prophylactic or preventative surgery are:
- Significant reduction in cancer risk (from 80-90% to 1-2%)
- Nipples can often be spared
- Women can get reconstruction at the same time
Of course, there are other aspects to consider, and it's important to speak with your healthcare provider about your individual risk factors and the benefits of a preventative surgery vs. more of a watch-and-wait approach.
All About Double Mastectomies
A double mastectomy is a procedure in which both breasts are removed to get rid of cancer. The procedure may also be performed as a preventative measure for women who are at a very high risk of developing breast cancer.
The procedure typically only takes a few hours, but may take longer depending on what type of reconstruction a woman has opted to get. Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don't have reconstruction at all.
"A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue," Dr. Port told SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
Dr. Port notes that these days, most women do opt to have some sort of reconstruction. The length of these surgeries can vary a great deal. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one's own tissue (usually from the belly area) and transfer it into the breast area but this is a much longer procedure.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says. “It can take anywhere from six to 12 hours because it's really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in.”
Questions to Ask Your Doctor
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- What are the benefits of using implants over my own tissue and vice versa?
- What will recovery look like after the procedure?
Contributing: SurvivorNet Staff
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