Let's get the facts...

Yesterday, I asked a very controversial question. Why would a woman choose to remove her breasts and ovaries? I think you need to know the science behind this question. Today I am going to start out at BreastCancer.org.

A - ducts
B - lobules
C - dilated section of duct to hold milk
D - nipple
E - fat
F - pectoralis major muscle
G - chest wall/rib cage

Most breast cancers begin in the lobules or ducts. Lobules produce breast milk; ducts deliver it to the nipple. (The Breast Reconstruction Guidebook)

By removing breast tissue you can dramatically reduce your overall risk. Consider this number, mastectomy alone can reduce your 87% lifetime chance of breast cancer by 90%. This surgery alone will bring your risk down to about the general populations. It does not take your risk away completely though. Another factor to take into consideration is that not everyone who is at risk will develop cancer. This makes it a very tuff choice.

There have been several discussions around my parents dining room table about this very topic. I am very passionate about this subject, and I definitely have my opinions. One of the most debated items is that I have no way of knowing for sure if I will get cancer. Katie has it, but that does not guarantee that I will with or without surgery. So lets look at it this way, there is a 13% chance that I will never get cancer. Meaning I do not necessarily have to remove anything, I can talk with my doctors, be diligent in the surveillance procedures, and continue to be perfectly cancer free until the day that I keel over from old age. Sounds like a pretty good option to me, but the decision is ultimately yours.

Lets talk about ovaries. As you dive into my world you will eventually see that there are differences in BRCA1 and BRCA2. Typically BRCA1 positive patients have a higher risk of developing ovarian cancer than their BRCA2 counterparts. Those with BRCA1 mutations remove their ovaries ultimately to reduce their risk of ovarian cancer. An 85% reduction in risk to be exact. This is a positive thing in my mind, but once again no one is guaranteed they will get cancer. Those with the BRCA2 mutation remove their ovaries for two purposes. First to reduce the risk of ovarian cancer, but second because breast cancer related to BRCA2 mutation is more likely to be estrogen-receptor-positive. By removing your ovaries you reduce the amount of estrogen produced by your body dramatically. Why do we need to reduce the amount of estrogen our bodies make? The presence of estrogen in ER-positive patients increases the growth of cancerous cells and tumors. Basically, the cancer feeds off of estrogen. By cutting off the food source, you can restrict growth and sometimes even prevent it.

How young is too young creeps back into my mind here. Genetic testing is available when you turn 18, but how many of us have completed our families by then. In our career driven society many women have not even started having children at my age. There are other options to reduce the amount of estrogen in our bodies. Many of these relate to our birth control. Once again, talk to your doctor.

It may not be the right time for you to consider prophylactic surgery. As time goes by each of our circumstances change, and what seemed unrealistic yesterday may be our best option tomorrow. As I have mentioned before, Cody and I have been very open about this topic since my mom passed away 9 years ago. We made several of our decisions about having our children early and close together because of these discussions. I guess you could say that I have been planning my life around testing positive for this mutation. Many of you will say that is a little on the neurotic side. If it is OK then, but know this I have big plans for my life.

*The percentages given will vary between studies.