Issue link: https://read.dmtmag.com/i/179241
BRCA testing dominated news head- lines last spring when actress Angelina Jolie announced in The New York Times that she had undergone a preventive (or prophylactic) double mastectomy. Jolie chose the procedure because she inherited a mutated form of BRCA1—one of two genes every woman has that, when mutated, are linked to and can predict risk of breast and ovarian cancer. Jolie, whose mother died from breast cancer at the age of 56, was hailed for lending her well-known face to raise awareness, and her bravery for publicly detailing her deeply personal decision. When unmutated, BRCA1 and BRCA2 genes are responsible for preventing tumor growth, among other things. Thankfully, today, a blood test can easily detect the mutations which may increase a woman's cancer risk. But, only a generation ago, women like McMillan, with a family history of breast cancer, were often at the mercy of their hereditary fate. They simply had to wait and see if they too would develop cancer like their mother, aunt or sister did. These days, women have the power to learn the truth about their personal risk of developing breast cancer and the opportunity to reduce that risk by preventively removing their breasts. "Prophylactic mastectomies are on the rise because there is more publicity about breast disease [and BRCA] in general, and plastic surgery has improved," says Dr. Lee Wilke, a breast cancer surgeon and associate professor at the University of Wisconsin School of Medicine and Public Health. Wilke is also the director of the UW Health Breast Center, which provides screening, diagnoses and treatments for breast disease, as well as prevention services. Her colleague, Dr. Ahmed Afifi, who specializes in plastic surgery and reconstruction, agrees, calling the increase in preventive mastectomies a "worldwide trend." "Prophylactic mastectomies in patients without cancer have been around a long time," Afifi says. "But yes, it's becoming more common, and we're seeing younger patients showing an interest in the procedure. We are seeing testing as making a difference." For McMillan, the decision to remove her breasts wasn't an easy one. She's dreading the scarring and permanently altered appearance of her breasts. She also won't have the chance to breastfeed in the future and will lose a great deal of sensation in her breasts. However, McMillan says, the peace of mind she anticipates after the procedure far outweighs the downsides of a preventive mastectomy "I don't want to go through [cancer]. I'm a nurse. I've seen it firsthand," she says. "The earlier you do it, the higher your chances of not developing cancer." Other women like McMillan, who are in their 20s and 30s, face especially tough questions and concerns about fertility and timelines for procedures like mastectomies or oophorectomies (ovary removal)—often forcing them to struggle with life questions they weren't planning to answer. Should a woman go ahead and have a child now? Wait until they're more established financially or romantically? Have eggs harvested for later? "The longest part of the conversation is typically about children," says Dr. Lisa Barroilhet, an assistant professor of oncology at the UW School of Medicine and Public Health who works closely with women considering genetic testing. "When women ask me what I would do, I have no answer. It would take me a long time to make a decision," she says. Because of her family history, McMillan wanted a mastectomy as soon as possible so that she could move on and have children. Her mother dealt with the emotional roller coaster of having cancer while pregnant, and McMillan hopes to avoid that experience by being proactive. "At first I was turned off to it, like, what's going to happen if I'm in positive?" she says. "But I feel like I'm getting out there, and others should too. Take charge and figure this out while you can." OCTOBER 2013 | bravamagazine.com 53