According to some experts, having healthy breasts removed may be the most appropriate preventive approach for women carrying the genetic mutation. Relying on still inexact screening and surveillance to catch a tumour in its early stages may be just too nerve-racking for some women. A mastectomy, the cost of which is covered by provincial health insurance across the country, can significantly reduce the risk of getting breast cancer (some say by at least 90 per cent) although it does not eliminate the risks completely; it's impossible to remove all breast tissue, as it's so closely connected to skin and tissue in the armpit.
The operation is preventive, so it's not the same as a mastectomy to treat cancer, says Kelly Metcalfe, a research scientist who works with Narod and at the University of Toronto. "No lymph nodes are removed, and most women have reconstruction within the same surgery."
And for women who want to alter their appearance as little as possible, they can opt for an operation that uses tissue from elsewhere on their body to create realistic nipples.
While women do have to consider their psychological attachment to their breasts and how the operation might affect delicate issues of body image and intimacy, studies show that, emotionally, women do well after these surgeries. "A lot of us women in this situation don't see a breast the way other women do, because we've seen breast cancer take our sisters and our moms," Sheri points out. "So our breasts are almost the enemy." Moreover, the operation does not affect the patient's ability to have children.
Life saver
In Sheri's case, the surgery was definitely the right choice. After it was over, she got a huge shock: Cancer was already there, buried deep in the breast tissue. It was never caught on her mammogram. "I totally believe that the decision [to have a radical mastectomy] absolutely saved my life," she says.
Then, in 2003, Sheri had her ovaries removed, too. This procedure, called an oophorectomy, reduces the risk of ovarian cancer and can reduce the risk of breast cancer in premenopausal women.
Sheri is convinced she did the right thing, not only for herself but also for her children. "I lost a mom so young, and I just didn't want to put them through that. I don't want them to grow up watching their mom fight cancer."
But surgery isn't for everyone. In fact, only a quarter of Canadian women with a BCRA mutation opt for a prophylactic mastectomy. That decision may be influenced by such factors as personal experience with cancer, confidence in screening techniques, even age and culture. In contrast, 70 per cent opt to have their ovaries removed. Perhaps women consider this a less drastic surgery that still reduces breast cancer risk by half. Plus, ovarian cancer is difficult to detect before it's at an advanced stage.
For those who reject the mastectomy option, for whatever reason, the drug tamoxifen can cut the cancer risk by half. The drug slows cancer growth by blocking the effects of the body's estrogen in breast tissue (although it has been proven effective only for BRCA-2 positive women).
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