Preventive mastectomy: young women who had their breasts removed to avoid breast cancer

At the age of 23, the project coordinator, Evelin Scarelli, was surprised with the diagnosis of breast cancer. With no family history of the disease, the young woman had two different tumors in her left breast, and soon began treatment to fight them.

Two years later, Evelin was surprised to be diagnosed with the disease once again, but now it was her mother who would face the entire breast cancer treatment.

The illness of the mother and daughter sparked the alert of the doctors who accompanied them — there was a possibility that the tumors had a genetic origin. In order to prove or not the suspicion, genetic analysis of mother and daughter was requested to detect whether they had mutations in the BRCA1 or BRCA2 gene.

And the doctors’ suspicions were confirmed. Evelin was diagnosed with a mutation in the BRCA1 gene at age 25 and with the diagnosis came the information that she had about an 85% chance of having a new breast cancer.

Without thinking too much, the project coordinator decided to undergo breast removal surgery to reduce the risks of the disease. Risk-reducing surgery or preventive mastectomy, as it is known, decreases the chances of a patient who has the gene mutation having breast cancer by 90 to 95%.

“Removing the breasts is a very difficult decision because it is an irreversible procedure, since we are talking about the removal of an organ. But I, who had already undergone treatment, saw my mother also face cancer and faced the removal of the breasts as the chance for me to assume the role of the protagonist of my life and not let the disease dominate me”, he says.

At the time of the diagnosis, Evelin and her husband were preparing to undergo an IVF (In Vitro Fertilization) and thus try to fulfill their dream of having their first child. In addition to the fear of the disease, came the concern of not being able to breastfeed, something that had been long awaited and planned by her.

“The speeches about breastfeeding are very heavy, society imposes that to be a mother you need to breastfeed and there is a lack of sensitivity with mothers who do not do this. Breastfeeding is much more than that, it is a link from heart to heart. there’s a lot of misinformation and it’s a barrier that needs to be broken,” says Evelin.

Shortly after the removal of both breasts, Evelin underwent breast reconstruction surgery with the placement of prostheses and had limited movement in the months that followed. Last year, after the second IVF, the dream of being a mother was fulfilled and her first child was born.

“I underwent two fertilizations, the first was a girl and the embryo did not develop. On the second attempt we managed to have our son Bento. Removing my breasts was a very safe decision. I wanted to have the procedure to be able to celebrate the life of my son and have the chance to see him grow”, he says.

‘I’m not less of a woman for not having breasts’

It was also after facing breast cancer in 2020 that manicurist Esther Marília da Silva Oliveira, 37, discovered that she had the BRCA1 gene mutation. After two years of treatment with chemotherapy and radiation, the doctors ordered the genetic mapping as a precaution and the diagnosis came.

“My doctor called me for a conversation and explained about the preventive mastectomy, which greatly reduced the chance of me having the disease again, I embraced the idea of ​​having the procedure and removing my two breasts”, he recalls.

The manicurist, who has a stepson, says that she had no desire to be a mother and that the removal of her breasts did not affect her in that regard. The procedure, which also included the removal of the ovaries and tubes, was performed in February this year and initially Esther chose not to place breast implants.

“I faced the surgery in a very natural way, because what I wanted was my cure, to have a quality and long life. I wanted to take away from me the possibility of having a new cancer”, he says.

Despite the conviction of her decision, the manicurist recalls that she did not tell her friends and family about the breast removal procedure to avoid judgments and opinions contrary to her decision that could impact her emotional state.

“The only person that worried me was my husband and he supported me to have the surgery without the reconstruction of the breasts. It is a new phase for the couple and we are getting used to the new life. I think about rebuilding my breasts. I’m not less of a woman for not having them”, she says.

‘Netflix series helped me discover my mutation’

Unaware of the BRCA1 and BRCA2 gene mutation, which increases a person’s chances of getting breast cancer, publicist Stefania Dominique Carnevale de Luca, 26, discovered that she could suffer from the problem by watching a Netflix series called The Bold Type.

After seeing the episodes in which the main character and her mother had breast cancer, she decided to investigate her own genetics, as her mother had recently faced the disease.

“I didn’t know that this mutation existed and the series warned me about it. When I found out I was mutated, I was distressed, in shock and the first thing that crossed my mind was that I didn’t want to have cancer. I needed to act on that, regardless of what the possible consequence might be”, he recalls.

Initially, the publicist, with the doctor accompanying her, opted for the removal of the breasts with the reconstruction of the breasts with prostheses. However, two weeks after the procedure, Stefania had complications due to the surgery and had to remove the prostheses, leaving her breasts.

“I had a moment of mourning, for two days I only cried because I would have to be without my chest for a few months and that scared me a lot. But soon I recovered, I started to thank you for my health and for being able to lead a normal life, doing everything what I like the most, like running, cycling and traveling. Little by little I started to love my new body”, he says.

In December, the publicist will undergo a new surgery for the placement of prostheses in both breasts. In addition to the aesthetic change, the detection of the genetic mutation made Stefania advance her plans to have children for the next year.

The safest way for patients with a genetic mutation to have children, according to doctors, is through in vitro fertilization, in this way it is possible to prevent the mutated gene from passing to the baby.

“It may be that in the future I have to remove the tubes and ovaries, so I intend to have a child soon. When I went to remove the breasts, one of my concerns was about breastfeeding. But I looked for a breastfeeding consultant to understand how it is feeding a newborn with formula and she reassured me. So I decided to give up breastfeeding for the sake of my health”, he explains.

‘Lack of support made me give up on surgery’

The decision to remove the breasts most of the time is not easy and can shake the psychological of women. That’s what happened to nursing technician Amanda Dias Ruivo, 26 years old.

After the mother and aunts were diagnosed with breast cancer, the hospital asked the nursing technician to do the genetic mapping to analyze the probability of Amanda also having the disease in the future.

“I took the exam in 2019 and was diagnosed with the BRCA1 mutation. At the time I already had some nodules in my breast, but after the biopsy it was found that they were not tumors”, she says.

Amanda was informed by the doctors about the breast removal surgery and decided to do the procedure. However, with the date approaching, which would be this month, she gave up the procedure, opting for medical follow-up and exams every six months to check for the appearance of nodules.

“In my family, my cousins ​​didn’t want to do the genetic mapping and they look at me as if I were looking for a disease. I had a lot of lack of support from people in this process because they don’t see it as prevention. In addition, the aesthetic issue was something that weighed , there’s no denying it. I can’t imagine myself without my breasts and that’s why I decided to postpone the surgery until I feel ready for the procedure”, she says.

As Amanda is a carrier of the gene that can manifest itself at any time, in addition to regular medical follow-up, she is also restricted in relation to the use of contraceptives and medications that affect her hormones.

BRCA1 and BRCA2 mutation

Having a grandmother, mother or sister with breast cancer does not mean that the mutation is present. Only 0.2% of the population has mutations in the BRCA1 and BRCA2 genes, and about 0.1% has the mutation in one of them.

A mutation in BRCA1 increases a person’s risk of developing breast cancer by approximately 40%. The BRCA2 mutation also increases the risk of breast cancer by 40% and ovarian cancer by 12% to 15%.

Risk-reducing surgery or preventive mastectomy — like the one performed by Evelin, Esther, Amanda and so many other women — can reduce your risk of breast cancer by up to 95%.

The guarantee is not 100% because it is possible for a tumor to develop in some remnant of breast tissue or in the breast ducts. The placement of the prosthesis can be done in the same surgery in which the breasts are removed or the patient can choose not to place the prosthesis.

“When of genetic origin, breast cancer affects subsequent generations earlier and earlier, in an interval of eight to ten years”, explains Vilmar Marques, physician and member of the Brazilian Society of Mastology.

“For example, if the mother had cancer at age 40, it is possible that the daughter will have the tumor at age 30; therefore, it is important to be aware of family genetics and in the case of BRCA mutations we recommend that follow-up is carried out from the age of 25 years. In addition, for the removal of the breast, the patient must have psychological follow-up to prevent her from suffering from disorders in the future.”

How to prevent breast cancer

Breast cancer is the type that most affects women worldwide. In Brazil, 66,280 new cases of the disease were estimated for 2022, according to the National Cancer Institute (Inca).

Discovering breast cancer early is very important and greatly increases the chances of curing the disease. When diagnosed in stage 1, the chances of cure reach 95%, and treatments, in general, are less invasive, unlike the other stages.

Having a balanced diet and exercising regularly are basic recommendations to prevent breast cancer, as being overweight increases the risk of developing the disease, according to the Brazilian Society of Mastology.

It is not yet certain whether the use of birth control pills is associated with an increased risk of breast cancer. But women who used high-dose estrogen oral contraceptives, who used the medication for years and those who started using contraceptives at an early age, before their first pregnancy, may be more predisposed to have the disease.

This text was originally published here