H
aving both breasts surgically
removed is a radical decision for
any woman, but particularly for an
actress whose roles showcase her
blond beauty and pert figure. in
July 2008 christina applegate—
current star of aBc’s Samantha
Who? and best known for playing
sexy airhead kelly Bundy on the Fox
sitcom Married ... With Children—
had a double mastectomy after
being diagnosed with breast cancer,
in april, at age 36. shortly after
that diagnosis, applegate tested
positive for a Brca1 gene mutation,
a serious hereditary risk factor.
applegate’s mother had twice
faced breast cancer. “there was
this part of me that sort of knew
that the other shoe was gonna
drop,” applegate explained in an
emotional appearance on The
Oprah Winfrey Show just five weeks
after her surgery.
knowing she carried a dangerous
gene mutation “changed
everything,” applegate told oprah.
women with a Brca1 mutation who
develop a first tumor by age 50, as
applegate did, face a 40 percent
chance of developing cancer in
their other breast within 10 years.
Lumpectomy and radiation might
eliminate her first tumor, applegate
reasoned, but “it wasn’t addressing
the issue of this coming back, or
the chance that it could come back
in my left breast.”
the medical benefits of acting
pre-emptively are clear: a
prophylactic mastectomy reduces
the breast cancer risk for women
with a strong family history of
the disease, or with a Brca1 or
Brca2 mutation, by at least 90
percent—and, along with it, much
of the grinding anxiety they face.
(while about 12 percent of women,
in general, will develop breast
cancer in their lifetimes, for women
who carry a Brca1 or Brca2
mutation, that risk rises to between
56 percent and 85 percent.)
“there’s no other prevention
method, right now, that offers
a mutation carrier that great
a reduction in her risk,” says
psychologist Leslie schover of the
M. d. anderson cancer center, in
Houston. “the problem,” she adds,
“is that it comes with a price.”
that price involves removing
a healthy breast along with a
cancerous one (a procedure known
as contralateral prophylactic
mastectomy) or removing both
healthy breasts before a tumor
ever appears (bilateral prophylactic
mastectomy).
currently, only about 20 percent
to 30 percent of high-risk women
in the U.s. choose prophylactic
surgery. “it’s such a huge thing
to do, and it seems so mutilating,
to take healthy tissue before you
know that you have a tumor,”
says schover, who studies the
psychological impact of cancer’s
toll on sexuality and fertility. and
while physicians and genetic
counselors routinely tell high-risk
patients to consider this option,
they have little guidance to offer
about how to make this complex,
highly personal decision. “that’s
the mantra: you should think
about this, but it’s a very personal
decision,” says psychologist
andrea Farkas Patenaude of the
dana-Farber cancer institute,
in Boston, who studies the
psychological adjustment of
people undergoing cancer genetic
testing. “But that’s the end of
the conversation rather than the
beginning.”
research is slowly accumulating,
however, about women’s prophylactic
mastectomy experience—helping
to paint a picture of what life is like,
emotionally and physically, after
surgery. “a lot of women make very
good adjustments,” Patenaude
emphasizes. the vast majority,
more than 80 percent, experience
a dramatic reduction in cancer-related anxiety. Psychological
distress after surgery, however, is
also common; a sizable minority
of women struggle with their
body image, for instance, and with
problems in their sex lives.
CR | Page No. 31 | www.CRmagazine.org
