Deciding on the Right Treatment
- Singer and actress Coleen Nolan, 58, shared advice her sister battling breast cancer gave her before deciding if a prophylactic double mastectomy was the best decision to reduce her breast cancer risk.
- Prophylactic (preventative) double mastectomy is a procedure woman at higher risk of breast cancer undergo to reduce their cancer risk hopefully.
- A double mastectomy is a procedure that removes both breasts. Some women choose this procedure to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.
- BRCA comprises two genes, BRCA1 and BRCA2, which are tumor suppressors. When either of these genes is altered, damaged DNA cannot be adequately repaired, leading to an increased risk of breast and ovarian cancers.
- Several genetic tests are available to determine if you have the BRCA1 or BRCA2 gene mutation.
The family of singer and actress Coleen Nolan, 58, has been wracked by cancer in one form or another over the years. Coleen, hoping to curb her chances of developing breast cancer, considered getting a prophylactic double mastectomy. However, her sister Linda, 64, who’s currently battling the disease, advised her against it because of how the procedure made her feel afterward.
“It wasn’t a big decision for me,” Coleen said on a recent episode of the Mother and Daughter Breast of Friend podcast.
Read More“I was making inquiries into it and talking to my breast specialist. He was saying it wasn’t a bad idea, but to go to (mental health) therapy as it was a big decision. But it wasn’t a big decision for me because if I have a faulty gene, I want it gone. And I’d get decent boobs after!” Coleen Nolan told Bella Magazine.
We should note that the Nolan sisters tested negative for the BRCA gene mutation, which increases your risk of developing cancers such as breast and ovarian, according to U.K.-based news outlet The Mirror.
Linda’s influence was compounded when she told her sister she could still develop cancer elsewhere in her body despite getting a mastectomy.
Nolan is a British-born actress best known for her roles on “Ant and Dec’s Saturday Night Takeaway, ” a game show with sketches and special guest appearances. She’s also had roles in “Lemon La Vida Loca” and “Angela and Friends.”
Coleen was diagnosed with basal cell carcinoma – a type of skin cancer – last year after initially mistaking symptoms as eczema.
Nolan said her dermatologist discovered the basal cell carcinoma on her shoulder and urged her to get it treated. The actress admitted the uneasiness of seeing her doctor despite feeling okay.
“It was carcinoma, and then the melanoma on my face is something that is pre-cancerous melanoma that if I don’t sort it then much later on in life, it will turn to skin cancer,” Nolan described.
Helping Patients with Treatment Decisions
Decision-making When Considering a Mastectomy
When a woman decides to have a mastectomy, several factors go into that decision. Among things to consider is whether to have breast-conserving surgery such as a lumpectomy. These decisions should be made alongside your doctor by openly and candidly discussing risks vs. benefits.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Happens During a Double Mastectomy
Other factors that weigh into the decision to get a mastectomy are the size and features of the tumor and your family history. However, the gravity of your decision comes into full view, especially if you choose to get a mastectomy and remove both of your breasts.
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.
Dr. Port added that most women do opt to have some 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 during reconstruction.
Understanding the BRCA Gene Mutation
BRCA is comprised of two genes: BRCA1 and BRCA2. Both BRCA1 and BRCA2 contain proteins that work as tumor suppressors.
They help repair damaged DNA and ensure the stability of each cell’s genetic material.
When either of these genes is altered, that mutation can mean its protein product does not function properly. The result of a nonfunctioning protein means damaged DNA may not be repaired correctly.
WATCH: Understanding BRCA Gene Mutation
BRCA1 and BRCA2 can increase the risk of female breast and ovarian cancers.
Several genetic tests are available to determine if you have the BRCA1 or BRCA2 gene mutation. Hereditary genetic testing is usually done with a blood or saliva test.
If you discover that you do have a mutation, there are options available to manage your cancer risk, which include:
- Enhanced screenings
- Prophylactic (risk-reducing) surgery, which involves removing as much of the “at-risk” tissue as possible
- Chemoprevention, or the use of medicines to reduce the risk of cancer.
What to Consider When Weighing Preventive Mastectomy?
A prophylactic, or preventative, mastectomy is an operation where the breast tissue is removed to prevent cancer from developing in the future.
“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.
“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.
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.
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
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my tissue and vice versa?
- What should I know about implants? Should I opt for preventative surgery?
- What will recovery look like after the procedure?
- What are the benefits of a watch & wait approach vs. preventative surgery?
- What kind of surveillance is required after the surgery?
Learn more about SurvivorNet's rigorous medical review process.