Reducing Risk for Breast Cancer
- Italian fashion model Bianca Balti, 40, learned she had an increased risk of getting breast cancer a few years ago, and undergo a preventative double mastectomy to lower that risk. Now she’s hoping that her story, about how has the BRCA1 gene mutation, will inspire others to get their genes checked and get their annual mammograms.
- When the BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) genes have mutations, people are at a higher risk for certain cancers.
- According to the National Cancer Institute, 55 to 62 percent of women who inherit a harmful BRCA1 variant will get breast cancer by the time they reach 70 to 80 years old.
- According to one of our experts, women who are at an increased risk for breast cancer because of BRCA mutations have three options: intensive surveillance, medication and prophylactic (preventative) surgery.
- While preventive mastectomies are effective in reducing a woman’s risk, she should carefully weigh the benefits with the risks with their doctor.
Balti, a loving mom of two who strives to be a “good role model” for her daughters, learned she had an inherited BRCA1 gene mutation back in 2022, after she decided to get a saliva gene test as she neared the age one of her paternal aunts had passed away from aggressive breast cancer, she revealed in a recent interview.
Read MoreSpeaking to Vogue, the 5-foot-9 fashion model admitted it was a “strange situation” that led her to get take a gene test. But when she learned she had a gene mutation that raised her risk for breast and ovarian cancer, Balti decided to take action.View this post on Instagram
She explained, “I wasn’t sick, yet … but I knew the chances were much higher that I would be one day. And I now had the free will to do something about it.”
Balti, who underwent preventative double mastectomy on December 8, 2022, recounted why she wanted to get surgery and lessen her chances of being diagnosed with cancer in the future, saying, “I wanted to be a good role model for my daughters and take care of my health.
“The hardest part of this entire process has been the fear. Of finding out the diagnosis, the unknown, of taking time off work, of not knowing how my body will look.”
Balsi, who is known for her runway work with luxury fashion brands such as Fendi, Prada, Gucci and Valentino, continued, “Obviously, how we look should be the last of our concerns. Life should be our concern, but many women do care.
“My relationship didn’t change with my body throughout the process, which I think was actually a big win. I feel the same, comfortable. Except for that I have this knowledge, which is powerful.”
View this post on Instagram
Although Balti has underwent a double mastectomy, she still aims to remove her ovaries in the future. But in the meantime she wants to inspire others to check if they are positive for the BRCA mutations.
She concluded, “Every time I speak publicly about what happened to me, people will reach out and tell me they did a mammogram or had their genes tested.
“So I know it actually makes a difference when you talk about it.”
Balti also took to Instagram at the start of this year to inform her fans on her decision to have a double mastectomy, writing, “LOVE YOUR SELF! Love is action, not words. When I chose to undergo a double mastectomy last year to substantially reduce my risk of contracting breast cancer, I felt empowered by this act of self love.
“Whenever I make time for my health, whether physical or mental, whether in the small daily actions or during the hardships of life, I’m giving true meaning to my existence. I used to think that making time for myself was selfish, but I came to realize that without taking care of me I can’t take care of nobody else; and as a parent I don’t have that luxury.”
She ended her post by inspiring her women followers to make “new resolutions,” adding, “Let’s invest in ourselves. Let’s give ourselves time, space, boundaries, and ultimately some love!”
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.
As per 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.
More Breast Cancer Information
- Is a Preventative Mastectomy Right for Me?
- Genetic Testing: What Is It and Why Is It Important? An Interview with Breast Cancer Previvor Erika Stallings
- Advances in Metastatic Breast Cancer Treatments Over the Last Year Offer New Hope for Those Fighting
- For Breast Reconstruction After Mastectomy, Women May Choose ‘Now,’ ‘Later,’ or ‘Never’
- Implant Reconstruction After a Mastectomy: The Options
“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.”
If you have a family history of cancer, 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.
When Cancer Runs in the Family: Survivor Amy Armstrong On The Importance of Genetic Testing
“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,” Dr. Port explained.
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. “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,” she explained.
“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.
Dealing With Fear & Anxiety After A Diagnosis
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.
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 own 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?
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
