Some Women Choose Double Mastectomies to Guard Against Breast Cancer

By Rachel Saslow
Washington Post Staff Writer
Tuesday, April 7, 2009

Karen Aulner, 36, has never been given a diagnosis of cancer. She has, however, been watching her older sister fight the disease since 2000. So when Aulner tested positive in 2004 for a gene mutation that put her at high risk of breast cancer, she asked her doctor to remove both of her healthy breasts.

"My sister was the healthiest person I ever knew," Aulner says. "She's slender, she worked out all the time, she loved fruits and vegetables -- and she's dying. If I could not have that happen to me? Heck, yeah."

Aulner is one of a growing number of women threatened by cancer who have opted for a preventive bilateral mastectomy: surgery to remove both breasts. The procedure has become more common not only among women with cancer in only one breast but also for women with no cancer at all.

The choice has been driven in part by the availability of tests that can identify mutations of the BRCA1 and BRCA2 genes, which increase a woman's risk of breast cancer. It also is related to more-sophisticated surgical options, including breast reconstruction from a woman's own tissue. But to remove both breasts remains a difficult and emotional decision, one that can reassure or haunt the patient for years.

A 2007 University of Minnesota study found that the percentage of U.S. women with cancer in one breast who chose a double mastectomy more than doubled over five years, from 4.2 percent in 1998 to 11 percent in 2003. Although the less invasive procedure called a lumpectomy is still far more common, the increase means there are more women who have gone through bilateral surgery and can provide advice or an example to others.

In March, Rep. Debbie Wasserman Schultz (D-Fla.), 42, revealed she had had a double mastectomy last year at the National Naval Medical Center in Bethesda. She had received a diagnosis of early-stage cancer in her right breast in December 2007 and had a lumpectomy. Then, she tested positive for the BRCA2 mutation and, after consulting with doctors and her husband, decided to have both breasts removed. She has had seven surgeries in all, including the insertion of silicone implants and having her ovaries taken out.

This all happened quietly, while she continued representing her district and campaigning, first for Hillary Rodham Clinton and then for Barack Obama. Even her children didn't know until two days before her news conference, which she held to promote earlier testing for breast cancer.

"The doctors said I had a 65 percent chance of a recurrence of cancer in the other breast," Wasserman Schultz said in a telephone interview. "Those odds were too high for me."

Her decision paid off immediately, she said: In some of the tissue removed from her right breast, doctors found a second cancer, a type called ductal carcinoma in situ.

Actress Christina Applegate had a double mastectomy last summer, inspiring a wave of articles and talk-show discussions. The 37-year-old star of TV's "Samantha Who?" had early-stage cancer in one of her breasts and tested BRCA1-positive. "I'm definitely not going to die of breast cancer," she said defiantly in a television interview. And of the benefits of reconstructive surgery: "I'm going to have cute boobs till I'm 90."

Like Applegate, many women who have chosen bilateral mastectomy describe it as the lifting of a great burden, because they no longer have to face the stress of mammograms or feel panicky if they find a small lump during a self-exam.

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