Preventive mastectomies on the rise

Michelle Kelley scratched an itch near her right armpit and felt a marble-size lump. Within days, the 28-year-old was diagnosed with breast cancer.

Aggressive breast cancers are being diagnosed more frequently in young women, experts say. And more of those young women are making the bold decision to remove their healthy breast along with the diseased one in order to amputate their fear.

Kelley is eager to end this chapter of her life. During the past eight months, the tumor and two affected lymph nodes were removed, a course of chemotherapy made her hair fall out and, twice, she feared the cancer had spread. "I had a cyst in my right armpit. Then I thought I felt something on the left-hand side. I don't want to live like that. They're just boobs," she said.

Her surgery is scheduled for November. "For me, I'm going to live life for the next 60 years. It's too much stress and anxiety," the mother of three said. She will undergo reconstruction that will use tissue harvested from her own body.

More women in the United States are choosing to have both breasts removed when cancer has been found in one breast. Researchers reported a 150 percent increase between 1998 and 2003 for the procedure, called contralateral prophylactic mastectomy, in a study published last year in the Journal of Clinical Oncology.

Dr. Gretchen A. Meyer with Lowcountry Hematology and Oncology has seen an increase in patients opting for the measure. "Most of my patients that proceed with bilateral mastectomy tell me that they did not want to have to worry about further monitoring of the opposite breast," Meyer said.

Primarily younger women are opting for the preventive mastectomy, researchers found after studying the National Cancer Institute's Surveillance, Epidemiology, and End Results database.

As screening technology continues to improve, more premenopausal women will be diagnosed, experts say. The median age at diagnosis is 61, according to the database.

Studies have shown the preventative surgery reduces the risk of new cancer and improves survival for women who have a history of breast cancer and other risk factors. Removal does not eliminate risk of breast cancer, but greatly reduces it. If any breast tissue is left behind, a certain amount of risk will always linger.

A woman who has been diagnosed with breast cancer has a higher risk of developing breast cancer again. Out of 100 women who have a history of breast cancer, about 10 will get cancer on the other side within 10 years. Add on additional risk factors, such as genetic abnormality or family history, and the likelihood increases.

Kelley did not test positive for the gene associated with breast cancer. But her first cousin developed the disease, and since her mother and her aunt are identical twins, Kelley and her cousin are genetically half-sisters.

Dr. Walter "Bo" Blessing, a surgeon with Surgical Associates of Charleston, said that the recent trend is a change in course for breast cancer treatment. "For the past 20 years we have moved toward less invasive surgery with lumpectomy and radiation instead of total mastectomy," Blessing said. "However, in the last three to five years, with the advent of new reconstructive techniques and breast MRI, more women are choosing mastectomy."

Dr. Jennifer Cranny, radiologist and director of women's imaging for Imaging Specialists of Charleston in Mount Pleasant, said newer technology, such as digital mammography and MRI, is responsible for finding more cancers in younger women.

"We're finding 3 millimeter cancers," she said. "You wouldn't feel that for more than a year."

Tammy Dye, 45, of Goose Creek credits education with her decision to undergo a double mastectomy in September.

"A lot of the reason it's not scary is because of all the information available," Dye said.

Dye's cancer was discovered with digital mammography at Trident Medical Center in July. Two tumors, too small to feel, were detected.

Dye's 39-year-old sister was diagnosed with breast cancer the day after Dye learned of her disease. Her sister has chosen a different treatment course, Dye said

Removing both breasts is a serious surgery that could affect one's self-image and sex life. Whatever women decide, they seem confident in their decisions.

A 2006 study funded by the National Cancer Institute found that more than 86 percent of women were satisfied with removing their second, cancer-free breast and did not have doubts. About 76 percent of those women were content with their quality of life.

Similarly, of those who did not choose preventive surgery, 75 percent were content with their quality of life.

"You have to decide what's right for you," Dye said.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.

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