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At LGH sisters opt for surgery to reduce breast cancer risk

5/9/2012 1:28:03 PM


“Breast cancer was always a big part of our lives,” says Jennifer. “I’ve always just assumed that I was going to get it; it was just a matter of time. But I never let my concerns get in the way of my living, especially when I became a mother.”

Her concerns weren’t irrational. Their father’s  family had a history of breast cancer, which put Jennifer and Lavonne at an even greater risk for developing the disease.

 “Each year I had annual mammograms that turned up nothing,” said Lavonne. “I’d keep thinking each time: ‘this could be it—the year it happens to me’."

Genetic testing through the University of Pennsylvania (Penn) Cancer Risk Evaluation Program at Lancaster General (LG) Health* confirmed what the family history suggested — both woman had a gene that made them susceptible to breast and ovarian cancer. Carriers of these genes have up to an 85 percent chance of developing breast cancer in their lifetimes. Positive identification of the genes usually points to a higher risk of ovarian cancer as well.

 “Our genetic counselor discussed our options in depth,” says Jennifer. Among them was increased screening including mammograms, MRIs, and ultrasounds about every six months.

A lifetime of surveillance, however, led Jennifer and Lavonne to a decision that made perfect sense to both of them. They chose elective surgery to remove their breasts.

They knew some may say their choice to have a prophylactic bi-lateral mastectomy was radical since they might never have developed breast cancer, but for them, the choice was a “no-brainer”.

Having a mastectomy was an easy decision for both of us,” explains Jennifer. “"To be tested every six months for the rest of our lives wasn’t an option for us. Thankfully, our husbands and family supported our decision completely.”

Both sisters’ children were too young to really understand what was going on but they tried to talk about it a lot. “I didn’t want my kids thinking I was sick or going into school saying ‘my mom has cancer,” says Jennifer. “I wanted to make sure they knew nothing was wrong and I was going to be in the hospital for a few days so that I wouldn’t get ‘sick’."

The sisters made an appointment with breast cancer professionals at LG Health Cancer Center, including surgeon Paul G. Newman, MD, FACS, and plastic and reconstructive surgeon, Alisha Arora, MD. Both sisters chose have reconstruction at the time of their mastectomies.

“Knowing everything involved with the procedures, we decided to space out our surgeries in order to support each other’s recovery,” says Lavonne. Jennifer went first followed by Lavonne several months later.

The initial surgery involved the complete removal of both breasts and the first stages of reconstruction. It required a brief stay in the hospital.

“Treating a person requires more than just removing the disease or the risk,” says Dr. Arora. “For these sisters, our surgical goal was to restore an appearance of normal anatomy in order to restore their quality of life after mastectomy.”

According to Dr. Arora, the first step of reconstruction for Jennifer and Lavonne involved the placement of balloon-like implantable devices called tissue expanders behind the chest wall muscle. Saline is then injected into the expanders through a metal port under the skin every week in order to gradually stretch the muscle and skin to a desired breast size. At the second stage of reconstruction, the expanders are removed and replaced with soft, more natural feeling permanent implants. A third step may be performed later to recreate the appearance of a nipple with what Dr. Arora describes as “origami of the skin” plus skin colored tattoos.

“Although the majority of women choose implants there are other techniques to reconstruct a breast that uses tissue from other parts of the body,” says Dr. Arora. “These are less common and typically more complex procedures involving a longer surgery and recovery.”

For Jennifer and Lavonne, explains Dr. Arora, these tissue-based procedures weren’t really an option due to their slender, athletic frames. Both sisters are very pleased with their outcomes.

Overall, the surgery reduced their chance of developing breast cancer by about 90 percent. Both sisters will still require annual examinations of the chest wall and, it was recommended for Jennifer to have a hysterectomy at age 40 or once she is through having children because of the associated risk of developing ovarian cancer. Lavonne had already undergone a hysterectomy, which revealed precancerous cells.

“I feel good about my decision to have a mastectomy and hysterectomy,” says Lavonne. “I feel a great sense of relief knowing I have done everything I can to be proactive. Now it’s out of my hands.”

Jennifer agrees. “It was the best thing for me to do. I’ve put it behind me and truly have no regrets. Ultimately, of course, it's an incredibly personal choice, one that women should make carefully, evaluating all the information available.”

Jennifer and Lavonne, along with their husbands are planning on running a half marathon together in the fall. “We love being active and healthy,” says Jennifer. “This was the best way for us to address the problem and move on with life!”

* Penn’s Cancer Risk Evaluation Program at LG Health is specifically designed for individuals with a personal history or strong family history of breast and/or ovarian cancer who want information about their risk and their family’s risk. The program also provides information for those individuals who have been diagnosed with cancer and want to know about the role of genetics in their diagnosis.

LG Health is one of 14 members of the Penn Cancer Network, and is the only member in Lancaster County. Built on a National Cancer Institute model for a community cancer center, the LG Health Cancer Center strives to offer the most effective and comprehensive cancer care available locally. However, when subspecialty care is needed, the Penn Cancer Network partnership ensures timely second opinions and referrals to Penn's Abramson Cancer Center in Philadelphia. The partnership also provides access to Penn's extensive clinical trials program offering Phase II and Phase III national clinical trials. These trials are used to evaluate the safety and effectiveness of a drug and to compare new treatments with the current standards.



 

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