"I Had a Double Mastectomy"
At 35, Claudine Basile made a radical choice to have a cancer-free future.
When Claudine Basile saw her gynecologist for an annual checkup a month after turning 35, he wished her a happy birthday and wrote a prescription for her first mammogram. "I said, ‘Why? I don't have breast cancer in my family,' " recalls Basile, a hotel executive in Boca Raton, FL. Her physician explained it was just to establish a baseline, so she scheduled the screening for later in the week. It turned out to be anything but routine. "One mammogram quickly turned into three, followed by an ultrasound and an MRI," says Basile. A few days later, her doctor delivered the shocking diagnosis: ductal carcinoma in situ (DCIS), an early, noninvasive form of breast cancer. Basile consulted two breast surgeons, both of whom said she was "lucky" because her cancer was small, self-contained, and would require only a lumpectomy. But before moving forward with the surgery, Basile sought the advice of a physician friend. Knowing she had lost her father three years earlier to pancreatic and liver cancer-two diseases linked to the breast cancer genes BRCA 1 and 2- her friend suggested Basile meet with a genetic counselor to see if she was predisposed to a higher risk of breast cancer. Three weeks after getting tested, Basile got her answer: She was BRCA-positive.Shocking oddsUp to one in 800 women carries a BRCA mutation (unlike Basile, a Sicilian Italian, most are of Eastern European Jewish descent), and they face strikingly worse breast cancer odds than the general population. BRCA-positive women have an up to 87 percent lifetime risk of developing the disease, often before age 50-compared with just over 12 percent among women without the genetic marker, who are more likely to be diagnosed after age 60. Their risk for ovarian cancer jumps significantly too, from less than 1 percent to up to 50 percent.
A woman who learns she must live with this genetic guillotine poised above her has several options: heightened surveillance, involving frequent screenings to catch the disease early if possible; preventive chemotherapy with drugs like tamoxifen, which reduces risk by about 50 percent in women over 35; and removal of the ovaries and fallopian tubes, which can slash the chance of breast cancer by up to 72 percent. Basile, who is currently single, decided she wasn't ready to lose her ovaries yet. "I'd like to have a child if the right guy comes along," she says.
But she did make another tough-some might say extreme-treatment choice: to have both breasts surgically removed. Known as a prophylactic mastectomy, the procedure has been shown to cut the risk of breast cancer by 90 percent in those with BRCA mutations. In Basile's case it would eradicate her DCIS and almost surely any recurrence of the disease. (The procedure can't remove every single cell, so there's always a chance that cancer will develop.) "I didn't want to live my life with this knot in my stomach," she says, "wondering every time I had a mammogram, ‘Is this going to be the one that shows cancer?' "Smart solution-or drastic measure?Hard statistics aren't available, but experts say that growing numbers of high-risk women are making this preemptive strike. It's a controversial choice. Some people regard the procedure as an overly dramatic response. Being at high risk isn't a guarantee you'll get the disease, after all-and even if you do, your cancer may be successfully treated. Also, research has not yet proved that "previvors," as women who have the surgery often refer to themselves, livelonger than those who don't.
Drastic or not, doctors say that postmastectomy regrets are rare. Women who decide to have the procedure often feel a greater sense of control over their own destiny. "Most, even those who had surgical complications or developed a more negative body image, say they'd elect to have it again because it brought them peace of mind," says Marlene Frost, R.N., Ph.D., researcher at the Mayo Clinic Cancer Center in Rochester, MN. It helps that mastectomy isn't remotely as mutilating as it once was, and that breast reconstruction can take place during the same surgical session as breast removal. Basile was also surprised-and thrilled-to find that she could keep her nipples. Doing so was long considered a dangerous practice because the milk ducts (where DCIS originates) converge toward the nipple, but physicians now realize that breast cancer virtually never develops in the nipple and surrounding tissue.
"In terms of appearance, the difference between removing and preserving the nipple is huge," says Joseph P. Crowe, M.D., chief of breast services at the Cleveland Clinic Foundation. "The effect [of preserving] is quite natural." Basile agrees, pleased with her transformation from a saggy 38DD to a perky 34DD. "I had my mom take pictures when I came out of the operating room, and my new breasts looked great-better than the originals," she says. Three weeks after the surgery last spring, she was back to work.
Basile has decided to take a few additional steps to reduce her risk of both breast and ovarian cancers: After giving herself a few more years to possibly conceive a child, she'll have her ovaries removed when she hits 40. And because ovarian cancer is very deadly-partly because it's often diagnosed at a later stage-she's screened with an ultrasound and a blood test every six months. Does she still worry about getting it? Sure, says Basile. "But in a situation that presents imperfect choices, I'm comfortable with the ones I've made to ensure my healthy future."