Tough decisions on breast cancer

August 21, 2008|By SUSAN REIMER

Christina Applegate is young, beautiful, famous and stunningly candid about her decision to have both breasts removed rather than live in dread that her breast cancer would return.

"I just wanted to kind of be rid of it," she said on Good Morning America this week. "So this was the choice I made and it was a tough one."

Applegate, star of Samantha Who? and, previously, of Married ... with Children, is just 36. She was found to have breast cancer in July, and it wasn't a surprise.

Her mother is a two-time breast cancer survivor, so Applegate had been getting mammograms since she was 30.

More important, the young actress tested positive for a mutation in what is called the breast cancer gene, BRCA1. It is a mutation she probably inherited from her mother, and it gave her a pretty fair chance of getting breast cancer herself.

While 12 percent of women will by stricken by breast cancer in their lifetime, up to 85 percent of those with the mutation will get the disease.

When it happened to her, Applegate made the decision to have both breasts removed and to go through a long reconstruction process rather than face the even greater odds that the cancer would recur.

"After looking at all the treatment plans, the one that was going to work for me was to have a bilateral mastectomy," she said during an interview with ABC's Robin Roberts, also a breast cancer survivor.

"I didn't want to go back to the doctors every four months for testing. ..."

"I'm clear," she declared. "Absolutely 100 percent clear and clean. It did not spread. They got everything out, so I'm definitely not going to die from breast cancer."

But the risk of ovarian cancer still looms.

Applegate said her mother had a hysterectomy. It may have been related to her breast cancer diagnosis.

According to Dr. Kathy Helzlsouer, director of Mercy Medical Center's Center for Prevention and Research, the fact that ovarian cancer, too, is linked to the mutation in the breast cancer gene means that Applegate's tough decisions are not over.

While 1.8 percent of women will develop ovarian cancer in their lifetime, up to 40 percent of women with the mutation will be diagnosed.

Applegate could elect to have her ovaries removed or have a complete hysterectomy. Like the double mastectomy, these procedures remove fear as well.

"She is dealing with a lot right now, but it is a discussion that needs to take place," said Helzlsouer.

"The difference here is that she has cancer. She is not simply at risk for cancer."

There are ways to monitor for ovarian cancer - ultrasound and testing for a marker in the blood - but they are not as effective as the advances in mammography - digital pictures, ultrasounds and MRIs. Ovarian cancer is a silent stalker.

"She needs to deal with what she is dealing with right now, which is the breast cancer," said Helzlsouer.

Research first identified the mutations in the BRCA1 and BRCA2 genes in 1994. Since then, Helzlsouer has been a pioneer in the sensitive counseling that this genetic testing allows.

What was once an utterly terrifying prospect - to have your breasts and your ovaries removed to take away cancer's stomping grounds - has become an option that women can now find the words and the breath to discuss.

"There is more acceptance," said Helzlsouer. "You are not crazy to be thinking of it."

Women who have been living with a family history of these cancers - a sister, a mother or an aunt - and who have watched the surgeries, the chemotherapy, the radiation, the hair loss, the disfigurement, the depression and anxiety have a deep understanding of what they might be spared if they elect to have these procedures.

That is what precipitated Applegate's decision, and it is exactly what propelled Abby Glassberg forward when she received the news that she carried the mutation in the breast cancer gene.

The 49-year-old Clarksburg commercial real estate broker had watched her sister, a breast cancer survivor, suffer and knew immediately what her decision would be. In February 2006, she had a double mastectomy and a hysterectomy - on the same day.

"My daughters won't have to watch me struggle like my sister's children watched her struggle," said Glassberg of her twin daughters, who are busy getting ready for their first year of high school while their mother trains for triathlons and marathons. Glass-berg will compete in the Iron Girl Triathlon on Sunday in Howard County.

"I've never looked back," said Glassberg. "It has allowed me to spend my time worrying about kid stuff instead of that other stuff. That is a great luxury."

When I spoke to her yesterday, her daughters had not mentioned the television star's decision and how close it is to home.

"It might be that it is a norm to them," said Glassberg. "Their mom did it, they know other women who did it."

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