Christina Applegate's choice to bravely undergo a double mastectomy puts her in the company of a growing number of women taking aggressive steps to avoid dying of breast cancer. A recent article in USA Today states that studies show more patients are choosing mastectomies, even though women are just as likely to survive if they have smaller, breast-conserving surgeries.
Some of this growing trend has been spurred by technology: MRI scans that can detect smaller, earlier cancers; sophisticated genetic tests that can warn women of their inherited risks like the one Applegate was positive for. Newer techniques in plastic surgery for that makes more aggressive surgery more appealing (we are now able to do free flap reconstruction with the patients' own tissues to rebuild the breast, or use newer generation silicone gel implants after tissue expansion for reconstruction). There is no doubt that some women are opting for mastectomy because their fear of cancer and mortality looms larger than the immediate appearance of their breasts postoperatively. Federal legislation mandates insurance coverage of breast reconstruction after cancer so this is good for patients too.
Applegate, 36, was at high risk for breast cancer, both because her mother had the disease and because she carries a rare genetic mutation in a gene called BRCA-1, which increases the risk of developing aggressive disease at a young age--women with this gene have up to an 84% risk of breast cancer. Applegate told Good Morning America Tuesday that she had early-stage cancer in only one breast and underwent two lumpectomies, and she that opted for a double mastectomy after learning of the genetic mutation. Only about 5% to 7% of breast cancers carry these mutations.
Some women with the mutations opt to have preventive mastectomies even if they haven't been diagnosed with cancer given their high liklihood of developing breast cancer in one or both breasts in the future. A recent study in the International Journal of Cancer, for example, found 18% of women with the mutations took this approach. Applause for Christina Applegate for bringing public awareness to a disease that is diagnosed in 1 in 8 women. I wish her all the best in her recovery.
Every woman should remember to do monthly self-breast exams, mammogram starting at 40 or even earlier or with an MRI with a positive family history, and to consult with their doctor with any abnormal findings.
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