Special Report: Double mastectomies

By: Vanessa Brown

As we near the end of Breast Cancer Awareness Month, we’re taking an in–depth look at a surgery we’ve been hearing more about, double mastectomies. Are they life–saving or too drastic? The answer may be different for everybody.

In a span of 18 month, the world witnessed three very public admissions from women in the public eye.

Amy Robach, Samantha Harris, Angelina Jolie – all, underwent bilateral mastectomies, but for different reasons.

America watched Robach’s diagnosis play out on television. Last October, the Good Morning America anchor got a mammogram on air. Then, the news that shook her to the core – breast cancer.

“I have decided to have a bilateral mastectomy. I’m going to be very aggressive, I’m 40 years old,” Robach said in November, 2013.

The red carpet correspondent got her diagnosis in the spring. By May 2014, she too had the surgery.

“For me it came down to percentages,” Harris said to Robach on GMA back in April.

Jolie went public with an op–ed in The New York Times. In May 2013, she told us about her “faulty” BRCA 1 gene that upped her likelihood of breast cancer to 87%. Her mother died of ovarian cancer at 56. Jolie’s genetic mutation put her at increased risk for both. With no sign of the disease, she took proactive measures. Though much was made of her double mastectomy, she penned the piece to shine her spotlight on genetic testing.

“The Angelina Jolie Effect” has been long lasting and global. A study published in the journal Breast Cancer Research in September 2014, shows the impact it’s having in the UK. According to its authors, in the months following Jolie’s story, medical referrals went up two–fold. Requests for BRCA 1 and 2 testing nearly doubled. Inquiries about her preventative procedure were also up.

Here in the U.S., another milestone – just one month after Jolie’s op–ed, a historic Supreme Court ruling. Jolie had written about the $3,000 cost of testing and how it was out of reach for many women. In a unanimous decision, the justices barred the patent on human genes. The company with it, Myriad Genetics, could no longer hold the monopoly. Competing companies spoke out with plans to offer the same tests for $2,200 and $995.

Even so, only about one in 10 breast cancer cases results from genetic mutations and not every family history falls into the Jolie gene category.

Vicki and Abri Hessheimer and Jeri Luft know the disease far too well. They represent three generations of Lincoln women with extensive ties to cancer.

Luft lost her mother to breast cancer at 10. Her aunt had it too. Her sister survived it, but ovarian cancer took another sibling. Her blood test for BRCA gene mutations came back negative. Still, she was diagnosed memorial day, last year.

“When it’s you. When it hits home, it’s a shock,” Luft said. “Someone says there’s a bee on you, you go get it off, get it off! That’s what I felt like, get the cancer out of me, whatever it takes.”

Luft saw so many mastectomies in her lifetime, getting hers almost felt second nature.

“That was not the frightening thing. Cancer in my body was frightening,” she said.

Her daughter began to worry about her future.

“It was starting to sink in… this could be my life,” Hessheimer said.

She saw cancer as her reality and she wanted to take control. So, like Jolie, she opted for a preventative bilateral mastectomy.

“I already had one lumpectomy. I had had I don’t know how many biopsies I’ve had done and that anticipation and that anxiety I was so tired of,” Hessheimer said.

Going under the knife just weeks ago on October 13th wasn’t easy.

“It took me another year before I finally went through with it, because it just, it was that hard,” she said.

The procedure is not without risk. It’s major surgery. Short–term, you can see bleeding or infection, fluid under the scar, delayed wound healing and scar tissue. In the long–run, you could lose sensation or develop body image depression. Also, there’s no guarantee breast cancer won’t develop because it’s impossible to remove every last cell.

“We can drop the risks 80/90%, but we’re not going to get it to zero. That’s the bottom line,” said their general surgeon, Dr. R. Michael Norris.

It’s an approach he said is not right for everybody. In some cases, other forms of treatment may be best. As for whether the publicity has caused a spike in mastectomies in his office, Dr. Norris said no. He said each decision is still uniquely made.

“I don’t see it being on the increase, I think there’s just more awareness of it,” he said.

It’s worth noting, a September investigation in JAMA, the Journal of American Medicine, compared mastectomies to other forms of treatment in a case study out of California. In early stage cancer, when compared to breast conserving surgery plus radiation, bilateral mastectomies did not improve the mortality rate. The figures were roughly about the same.

You can read more about the JAMA study here.

No matter the choice, when it comes to prevention or reaction, increased knowledge and support may be key to fighting this disease.

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