By Kyla Dunn
Life After Preventive Mastectomy
New insights reveal how high-risk women fare after removing healthy breasts
By Kyla Dunn
Having both breasts surgically removed is a radical decision for any woman, but particularly for an actress whose roles showcase her blond beauty and pert figure. In July 2008 Christina Applegate—current star of ABC’s Samantha Who? and best known for playing sexy airhead Kelly Bundy on the Fox sitcom Married ... With Children—had a double mastectomy after being diagnosed with breast cancer, in April, at age 36. Shortly after that diagnosis, Applegate tested positive for a BRCA1 gene mutation, a serious hereditary risk factor. Applegate’s mother had twice faced breast cancer. “There was this part of me that sort of knew that the other shoe was gonna drop,” Applegate explained in an emotional appearance on The Oprah Winfrey Show just five weeks after her surgery.
Knowing she carried a dangerous gene mutation “changed everything,” Applegate told Oprah. Women with a BRCA1 mutation who develop a first tumor by age 50, as Applegate did, face a 40 percent chance of developing cancer in their other breast within 10 years. Lumpectomy and radiation might eliminate her first tumor, Applegate reasoned, but “it wasn’t addressing the issue of this coming back, or the chance that it could come back in my left breast.”
The medical benefits of acting pre-emptively are clear: A prophylactic mastectomy reduces the breast cancer risk for women with a strong family history of the disease, or with a BRCA1 or BRCA2 mutation, by at least 90 percent—and, along with it, much of the grinding anxiety they face. (While about 12 percent of women, in general, will develop breast cancer in their lifetimes, for women who carry a BRCA1 or BRCA2 mutation, that risk rises to between 56 percent and 85 percent.)
“There’s no other prevention method, right now, that offers a mutation carrier that great a reduction in her risk,” says psychologist Leslie Schover of the M. D. Anderson Cancer Center, in Houston. “The problem,” she adds, “is that it comes with a price.” That price involves removing a healthy breast along with a cancerous one (a procedure known as contralateral prophylactic mastectomy) or removing both healthy breasts before a tumor ever appears (bilateral prophylactic mastectomy).
Currently, only about 20 percent to 30 percent of high-risk women in the U.S. choose prophylactic surgery. “It’s such a huge thing to do, and it seems so mutilating, to take healthy tissue before you know that you have a tumor,” says Schover, who studies the psychological impact of cancer’s toll on sexuality and fertility. And while physicians and genetic counselors routinely tell high-risk patients to consider this option, they have little guidance to offer about how to make this complex, highly personal decision. “That’s the mantra: You should think about this, but it’s a very personal decision,” says psychologist Andrea Farkas Patenaude of the Dana-Farber Cancer Institute, in Boston, who studies the psychological adjustment of people undergoing cancer genetic testing. “But that’s the end of the conversation rather than the beginning.”
Research is slowly accumulating, however, about women’s prophylactic mastectomy experience—helping to paint a picture of what life is like, emotionally and physically, after surgery. “A lot of women make very good adjustments,” Patenaude emphasizes. The vast majority, more than 80 percent, experience a dramatic reduction in cancer-related anxiety. Psychological distress after surgery, however, is also common; a sizable minority of women struggle with their body image, for instance, and with problems in their sex lives.