I have to admit, when I discovered I carry the infamous breast cancer-causing BRCA2 gene, I was floored. Although I knew, having a BRCA-positive parent, I had a 50/50 shot of being a carrier myself, I had lived for years with a sense of immunity.
Too many others in my family had already taken the fall, I thought. Even with 50 percent odds, four out of five of my maternal aunts and uncles had the gene, and my marathon-running, health-café-owning cousin had developed aggressive stage 2 breast cancer at age 32. Surely this genetic aberration had already overplayed its hand in our family.
And yet, there it was, in plain English, on my spit test results.
A pathogenic mutation was identified in the BRCA2 gene.
Translation: According to my report, I have a 74 percent risk of getting breast cancer by age 70. As I plodded through the phone call with the genetic counselor from the online testing company, it became clear I had a question to answer: What now?
I didn’t need the counselor to tell me that double mastectomy and bilateral ovary removal were a “popular” choice for those with this gene. (The BRCA genes also dramatically increases the risk of cancer of the ovaries.)
Not only did Angelina Jolie make international news with her decision for this kind of preemptive surgery, but I had also watched aunts and cousins undergo these painful procedures. And, prior to our family’s discovery of the gene, I had seen my mother suffer through an agonizing year of breast cancer diagnosis and chemotherapy.
The ball was now in my court. Would I follow the path of many of my family members — and thousands of other women — and go under the knife? Or take my chances with the future of my health? After careful consideration, I’ve come to my conclusion.
I choose — at least for now — not to pursue preventative surgery.
And here’s why.
Surgery is a big deal
I certainly don’t judge anyone who opts to surgically stop cancer before it can start, and I don’t believe most people who make this choice do so flippantly. But I’ve come to understand the enormous burden a double mastectomy and ovary removal would place on my health.
We’re not talking about getting skin tags frozen off. These are major surgeries that often come with complications. It’s an exhaustive list that can include:
skin loss
problems with wound healing
reconstruction failure
requiring a blood transfusion
Due to another health issue, I’ve already had one ovary removed, and it was one of the most traumatic experiences of my life. To remove the other would not only bring physical and emotional trauma, but would launch me into early menopause. As someone who is in their mid-30s, I’m simply not ready to face all that would entail.
I know there are many who would argue that the miseries — and potential fatality — of cancer are far worse than any potential complications of surgery, but for now, I can’t bring myself to slice away healthy, thriving parts of my body for fear of that risk.
You can still get breast cancer after double mastectomy
Even if I were to opt for surgery, a “results not guaranteed” asterisk underlies the procedure. Although it might seem like removing the site of potential mutation would eliminate the possibility of cancer, according to the National Cancer Institute, the surgery is 90 to 95 percent effective—not 100 percent. Good odds, yes, but not perfect.
I believe in lifestyle as prevention
Maybe it’s just because I’m a nutritionist by profession, but I have great faith in the power of lifestyle to prevent disease. Research abounds to show that a healthy diet, regular exercise, and limited alcohol consumption all play a major role in reducing the risk of breast cancer. Knowing I’m predisposed toward breast cancer actually motivates me to stay on top of healthy habits more than I would otherwise.
I find I’m more mindful about working in a yoga practice or deciding whether to have a second glass of wine. These choices may not completely outpace my cancer odds, but I believe they mitigate them. After all, about 30 percent of women with this gene don’t end up with breast cancer. A healthy lifestyle could make me one of them.
I believe in rapidly advancing science
Cancer research is one of the top-funded, most rapidly advancing fields of medical study. And from all indications, the science is making tremendous progress. From 1975 to 2012, five-year survival rates for women with breast cancer rose from 75 percent to 91 percent.
New therapies emerge all the time, from innovative drugs to targeted immunotherapies. Who knows what advances might be made in the next 5, 10, or 20 years? I feel confident that the options available to me in the future may be less invasive than surgery.
I still have time
According to the genetic counselor I spoke with, most BRCA carriers are advised to have surgery by age 40 if they are to have the best chance at preventing cancer. At 36, I’m staring down the barrel toward that critical birthday.
Still, even at 40, according to my results report, I only have a 17 percent chance of developing the disease. And while my risk increases with each decade of life, at this stage, I don’t feel the need to rush to surgical prevention.
The bottom line
It can be disturbing when I let myself think about how a mutation, that could suddenly set cancer in motion, lurks inside my body. I sometimes have the image of a ticking time bomb in my bra, or a creepy gremlin waiting to pop out of my chest, “Alien”-style. It’s not a pleasant thought. And, with my ever-increasing odds, there may come a time when I feel differently about surgical intervention.
For now, though, I simply try to live as healthy as possible. I eat fruits and vegetables, I go for my morning run, I limit my alcohol intake. And I hope for the day when preventative cancer treatment won’t require surgery.
Sarah Garone, NDTR, is a nutritionist, freelance health writer, and food blogger. She lives with her husband and three children in Mesa, Arizona. Find her sharing down-to-earth health and nutrition info and (mostly) healthy recipes at A Love Letter to Food.
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