More women opt for genetic testing, reconstruction

Dr. Ginny Barton, left, of Tullahoma OB/GYN As-sociates consults with Christie Shields, a breast cancer survivor who underwent preventive mas-tectomy and works as her receptionist. —Staff Photo by Marian Galbraith

STAFF WRITER

marian galbraith

According to the “key statistics” page on breast cancer from the American Cancer Society website, roughly one-eighth, or 12 percent of American women will be diagnosed with invasive breast cancer at some point in their life.

This year, an estimated 232,340 women will be diagnosed with invasive breast cancer, and of those, nearly 6 percent, or 39,620 will die from it.

Those who survive will undergo up to a year or more of stress and suffering with varying degrees of pain, discomfort, nausea, arm swelling, weakness, lost work, inconvenience and expense.

It’s no wonder, then, that preventive mastectomy is gaining popularity, even in women who are merely at risk for breast cancer but have not been diagnosed with it.

Actress Angelina Jolie made headlines this year when she chose preventive double mastectomy after genetic testing revealed she carried a faulty BRCA1 gene.

Doctors said the gene mutation gave her an 87 percent chance of breast cancer, and after watching her mother, Marcheline Bertrand, lose the struggle with ovarian cancer in 2007, Jolie wrote in a New York Times editorial this year that she “decided to be proactive and to minimize the risk as much (she) could.”

Doctors also told Jolie that by having the double mastectomy, her risk of breast cancer would drop to 5 percent.

Dr. Ginny Barton of Tullahoma Ob/GYN Associates told The News she feels Jolie’s decision was wise, based on her level of risk, and that she hoped more women in high-risk categories like hers will be inspired to follow suit.

“We offer the genetic testing here at our office,” Barton said, “and if you have a history of familial pre-menopausal breast cancer, we recommend getting it. And if you have a mutation that puts you at high risk, we recommend preventive mastectomy.

“It’s also important to get the test if you have any incidence of male breast cancer in your family.”

Dr. Ginny Barton, right, of Tullahoma OB/GYN Associates consults with Christie Shields, a breast cancer survivor who underwent preventive mastectomy and works as her receptionist.

—Staff Photo by Marian Galbraith

Most insurance companies will cover the cost of the genetic test if certain criteria are met, and prices range from $500- $3,000 depending on the type of test needed, but Barton said her office can find out in advance if a patient’s plan will cover it.

“There are two genes involved, the BRCA1 or BRCA2 gene,” she said, “and both are shown to be heredity indicators for breast and ovarian cancer.

“If either gene is mutated, your risk of both cancers is elevated.”

Fortunately, most insurance plans cover not only the mastectomy procedure, but also the cost of reconstructive surgery afterward.

According to several insurance company websites, including Blue Cross Blue Shield, the federal Women’s Health and Cancer Rights Act of 1998 requires all U.S. health insurers and self-insured group plans that cover mastectomy to also cover post-mastectomy breast reconstruction, as well as surgery on the other breast, if necessary, to create symmetry and treatment of post-reconstruction complications.

 

Advice helped survivor learn to self-examine

 

Although many women in Tennessee are now choosing preventive double mastectomy without the presence of cancer, others with existing cancer are choosing to remove both breasts when cancer is detected in either one.

Such is the case with Christie Shields, a breast cancer survivor and mother of three who also happens to be the receptionist at Dr. Barton’s office.

Shields was diagnosed with cancer in 2007 at age 36 after discovering a lump in her left breast during a self-exam.

“I had no cancer in my family and I was too young to have annual mammograms covered by insurance at that time,” Shields said, “but fortunately I found the lump myself.

“I was told later that my cancer was from too much hormone production.”

Shields said had it not been for the advice of a co-worker at her previous employer’s office in Winchester, she never would have checked her breast at all.

“One of my co-workers at Dr. Extine’s office said to me one day, ‘you mean you’re not checking yourself every month?’ and that’s when I started doing it.

“If not for her, I might not be here today.”

Nearly seven years after the incident, Shields still remembers the sequence of events as if it happened this year.

“I found the lump on a Friday, and the mammogram was scheduled for the following Wednesday.

“The next day after that, Thursday, I had the biopsy done and then met with the surgeon the following Monday.

“That’s when he told me I had stage three cancer and that I needed a mastectomy right away, so I had it done that Wednesday. So I basically went from discovery to mastectomy in about a week.”

While Shields said she could have begun the reconstructive process at the time of the mastectomy, she decided to wait until after chemotherapy was completed.

“I just wanted to get through chemotherapy and let my body heal from the surgery first before I went through the reconstructive part, which was also very difficult,” she said, adding that the process took months of time off from her job.

“Fortunately, my husband is in the service and has Tri-Care, and he had taken out a cancer policy for us the year before I found the lump.

“So I was very lucky. The cancer policy paid for everything, but it still took a lot of time and trips to Nashville.”

Shields added that the support of her co-workers was also crucial to her outcome.

“I had some amazing people behind me at work,” she said.

“Dr. Extine shaved his head in my honor when I lost my hair, and everyone else there was extremely understanding and supportive.”

After the first mastectomy and six months of chemotherapy, she began reconstruction on the left breast, which was a painful weekly exercise of inflating and stretching the breast tissue to accommodate an implant.

“They used some muscle tissue from my scapula area to hold the implant in place, so I’ve lost some arm strength as a result of that,” Shields said.

“I also get a lot of swelling from the lymphedema anytime I use my left arm, and I sometimes have to get injections for pain if I do too much lifting or moving things, like when I do volunteer work.”

 

Reconstruction procedure has improved over years

 

After a grueling year of chemotherapy trips, hair loss, breast pain, weakness, and countless other side effects, Shields said the decision to get preventive mastectomy in the right breast was a no-brainer.

“My husband and I talked about it and decided, after all that, it was better to just go ahead and get it over with,” she said, “so I did the mastectomy on the right breast the following January, and I’m glad I did.

“Dr. Joseph DeLozier was my reconstructive surgeon in Nashville and he was wonderful.”

DeLozier said the feeling was mutual.

“Mrs. Shields is a wonderful lady,” DeLozier said.

“We’ve also gotten much better at the process now than we were seven years ago, when she had it done, so there are fortunately several more options to choose from when considering preventive mastectomy.

“For example, some people want to conserve as much tissue as possible, while others want to get rid of as much tissue as possible that could become cancerous in the future.

“Fortunately, we have ways to accommodate both.”

Some options mentioned on DeLozier’s website include flap and tissue expansion techniques, as well as saline or silicone implants to restore appearance.

By taking muscle and fat tissue from the abdomen, for example, DeLozier said the breast can be rebuilt with the woman’s own body tissue while at the same time resulting in a “tummy tuck.”

While it can weaken the stomach muscles, DeLozier said some women prefer this natural-looking alternative that restores the breast’s appearance and improves the tummy area, too.

“The decision on whether or not to use an implant and expander depends on how much tissue and skin is left after the mastectomy, as well as whether the patient wants an overall reduction in breast size, or if an augmentation is desired,” he said.

DeLozier added that roughly a dozen of his own patients have opted for preventive double mastectomy this year, and he estimates that at least a few hundred women have done so across the state.

Asked if he thought some women might be tempted to get preventive double mastectomy purely in order to get the cosmetic surgery they have always wanted, DeLozier said no.

“From what I’ve seen, they just want to see their kids grow up,” he said.

Shields said her own breast reconstruction used muscle tissue from the scapula area as well as an expander, since there was not enough tissue left after her mastectomy to do without it.

The same procedure was used on the right breast, too, she said, to maintain body symmetry.

“They also created new nipples using skin grafts,” she said, “and I’ve been very happy with the result.

“They told me I can get tattoos if I want to, to make them look even more natural, but I don’t think I need it.

“I have some weakness in my arms now and I struggle with the lymphedema, but the appearance of my breasts was largely restored, other than a few scars.”

Another reason Shields said she recommends preventive mastectomy is that undergoing chemotherapy can leave lasting, unexpected side effects, such as destruction of the salivary glands.

“I started noticing dry mouth and I just thought it was because I was on the phone a lot,” she said, “but I recently went to the dentist and he said my salivary glands are just not producing enough saliva to prtect my teeth.”

With more sensitivity and tooth decay, Shields said her dental bills are suddenly getting higher.

“I’m glad I did chemo because I wanted to make sure and get rid of all the cancer cells and keep them from coming back,” she said, “but of course it’s better if you can avoid having go through it in the first place.

“I was only 36 when my cancer was found, but in retrospect, if I could have detected it soon enough, I would have gotten preventive mastectomy on both breasts and avoided the whole ordeal.”

On a positive note, Shields is proud to be entered in an upcoming Susan B. Komen 5K race for the Cure.

“This is my second time to do the 5K,” she said “and I’m very grateful to be able to say I’m doing it.”

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