Decision to have preventive mastectomy is tough, even when cancer risk is high
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By | The Tampa Tribune
Published: October 04, 2011
Published: October 04, 2011
When Sara McGregor first learned she had a genetic predisposition for breast cancer, she thought she could fend off the disease with an anti-cancer diet and by eliminating caffeine.
She and her middle sister, Katy, went together for genetic testing a few years ago because their oldest sister had breast cancer. Sara tested positive for a mutation in a tumor-suppressor gene, which put her at a high risk of developing cancer. Katy tested negative.
And then in July 2010, Katy was diagnosed with breast cancer. Her negative test result had been an error; she was retested and came up positive.
By this point, their sister Jill was dying. She passed away in October at age 49. Katy, meanwhile, was undergoing chemotherapy.
Sara, president of Capitol Catering in Alexandria, Va., felt as if her time was coming, and it scared her. She didn't want to leave her son and daughter motherless. She couldn't handle putting her own mother through the agony of diagnosis and treatment a third time.
More than 85 percent of women who get breast cancer do not have a family history of it, according to the American Cancer Society. But women whose relatives have had the disease – on either parent's side – are at an increased risk of developing it themselves. The closer the relative, the higher the risk.
With so much at stake, those women can use genetic screening to find out if they are in danger rather than wait to see what a mammogram or self-exam reveals.
The genetic test the McGregor sisters had looks for mutations in the BRCA genes. Everyone has those genes, which normally would prevent cancer, but a mutation raises the chance of developing the disease. Sara's results and her family background made her a prime candidate for breast cancer.
Still, she struggled with what to do with that information, even when she decided her holistic methods were not enough.
"I was totally dragging my feet," says McGregor, 46.
She knew what awaited her after seeing both her sisters go through surgery – a painful recovery and reconstructed breasts that looked far from normal.
Months passed. Then, in February, her mother, part-time Sarasota resident Jackie Lewis, attended a luncheon with a panel discussion on advances in cancer treatment.
One of the panelists was Dr. Christine Laronga, clinical director of breast surgical oncology at the Moffitt Cancer Center in Tampa.
She talked about nipple-sparing mastectomies and how they can improve women's body image and quality of life. Lewis knew her daughter feared disfigurement and thought this could motivate her to go through with the surgery.
"I think the hardest part is consenting to that kind of surgery, which is very drastic, when you're feeling good. It's not ordinary," Lewis says. "But it's for the thinking person – it's for the wise person."
Laronga says with the nipple-sparing mastectomy, surgeons peel the skin off the breast, preserving the nipple but checking the base for atypical cells. Earlier nipple-sparing surgeries removed about 80 percent of the breast but left a ring of tissue around the nipple, "almost like a pillow-top mattress," Laronga says. The problem was that enough tissue remained for women to develop cancer there.
The new method reduces the amount of tissue left and gives women a more natural look once the breast is reconstructed, which helps them feel more confident and comfortable with their post-surgery body.
"Women identify their breast by their nipple," Laronga says. "A reconstructed nipple's never as good as their own."
That option was exactly what McGregor needed. She immediately made an appointment with Laronga at Moffitt. Though McGregor lives near Washington, D.C., she decided to go to Tampa for the surgery and stay with her mother for the recovery. A last-minute cancellation got her scheduled within two weeks.
A single mom, McGregor had just 10 days to fly back to D.C. and make arrangements for her children and business. The entire time, she was stressed out that she had waited too long and put herself at risk.
She had the surgery with Laronga and plastic surgeon Paul Smith on March 29, and she came back to Tampa for implants in June.
McGregor says she is thrilled with the results, she feels great and has returned to running four or five days a week.
What was hardest to grasp, she says, was that after fearing it for so long, she was not going to get breast cancer. She asked Laronga at a follow-up visit what kind of monitoring she should do.
"She looked at me and said, 'You will never get breast cancer, because you don't have any breasts,'" McGregor recalls.
"It was stunning."
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