‘People have choices’: Options beyond breast removal for women with high risk for cancer

Originally from PANTAGRAPH.COM

BLOOMINGTON – Vicki Varney of Bloomington shares the faulty gene that put her and actress Angelina Jolie at a higher risk of breast cancer.

Instead of reducing her risk by having both breasts removed with a double mastectomy and reconstruction, as did Jolie, Varney choose ovary removal surgery, tamoxifen and regular mammograms and magnetic resonance imaging.

Sarah Breeden of Normal was diagnosed with a condition that put her at higher risk of breast cancer. She chose double mastectomy.

Which woman was right? Both, actually.

“People have choices,” said Dr. John Migas, an oncologist with Mid Illinois Hematology & Oncology Associates in Normal.

“What Angelina Jolie did was reasonable,” Migas continued. “There are other options.”

“Get all the facts and make a decision that’s best for you,” advised Jolene Clifford, registered nurse and breast health navigator at the Community Cancer Center, Normal.

While a family history of breast or ovarian cancer is common in women diagnosed with breast or ovarian cancer, fewer than 10 percent of breast cancers and less than 15 percent of ovarian cancers are associated with genetic mutations, Migas said. Two mutations are breast cancer type 1 and 2 susceptibility genes (BRCA1 and BRCA2).

People with a family history of BRCA1 or BRCA2 mutations and people with a close family history of breast cancer should be tested for the mutation. Such testing is done at the Community Cancer Center.

“If a woman goes to a genetic counselor and is screened and qualifies for the test – if they find a true risk (for breast cancer) – insurance will pay for the test,” Migas said. Without insurance coverage, the DNA analysis would cost $3,800.

If a woman carries an inherited BRCA gene mutation, she will get an estimate as to her personal risk of breast and ovarian cancer.

Options are to do nothing; an oophorectomy to remove the ovaries, which reduces the risks of breast cancer by 80 percent because the mutation occurs in the ovaries and the breast; or to get a double mastectomy, which reduces the risk by 90 percent, Migas said.

“None of these things guarantees anything,” Migas said. “They are risk reduction techniques.”

Some women choose mastectomy with reconstruction because they don’t want to worry about breast cancer, Migas said.

Some women who are done having children opt for removal of the ovaries. Some wish to keep their breasts, believing mastectomy to be drastic when no cancer has been detected, Migas said.

For the past generation, the trend had been breast conservation.

“But there’s an interesting trend we are noticing in the younger population toward mastectomy,” he said. “But most still lean toward conservation.”

Women who keep their breasts may choose tamoxifen, an oral drug taken daily for five years, which interferes with the growth of breast cancer cells. Tamoxifen cuts the cancer risk by 50 percent, but its menopause-simulating side effects include hot flashes, fatigue, vaginal dryness, joint aches and risks of blood clots and uterine cancer.

“If you have an elevated risk, most insurance will cover the treatments,” including the double mastectomy with reconstruction and tamoxifen, Migas said.

Dr. Jeffrey Poulter, a plastic surgeon in Bloomington, said advances in breast reconstruction include immediate reconstruction, which limits the number of procedures required to reconstruct the breast(s) and new techniques and implants that give the breast a more natural look and feel.

“After the patient has decided to have mastectomy with reconstruction, my role is to give them back a form that can look and feel almost natural,” Poulter said.

For example, Poulter recently was trained and approved to begin using new specially shaped gel implants, which are different from traditional round implants.

“Decreasing the risk of cancer does not have to deform the patient,” Poulter said. “There are excellent options for reconstruction to help women with their decision.”

Jolie announced earlier this month that she had the faulty BRCA1 gene, which gave her an 87 percent risk of breast cancer. She chose a double mastectomy, with breast reconstruction, to reduce her risk to 5 percent.

“Since Angelina Jolie’s announcement, a lot of women have heightened awareness and are wondering whether they should be tested,” Migas said. They should discuss their risk with their doctor.

If they test positive for the gene, they should know that there are options other than mastectomy, Migas and Clifford said.

Jolie’s example, Poulter said, proves “that a woman can maintain her femininity and appearance as well as care for her health.”

Jeffrey S. Poulter is a board-certified plastic surgeon with over 22 years of experience and 20,000 patients, with offices in Bloomington and Peoria. For more information, request a consultation, call (309) 663-1222 or visit www.drpoulter.com