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Sunday, May 19, 2013

Jolie brings mastectomy into spotlight for Greater Nashua women

You can’t battle cancer without making some sacrifices, as Christina Boucher knows.

“I loved my large chest; now I have issues filling a regular D cup,” Boucher, of Nashua, said during an interview requested by The Telegraph after news broke about actress Angelina Jolie having a double mastectomy because of a high genetic risk of getting breast cancer. ...

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You can’t battle cancer without making some sacrifices, as Christina Boucher knows.

“I loved my large chest; now I have issues filling a regular D cup,” Boucher, of Nashua, said during an interview requested by The Telegraph after news broke about actress Angelina Jolie having a double mastectomy because of a high genetic risk of getting breast cancer.

Boucher, 31 and the mother of three young children, had a double mastectomy in July 2012 for the same reason as Jolie: She carries the dangerous gene called BRCA-1 (pronounced “braca-one”), and has relatives who succumbed early in life to breast cancer and ovarian cancer. That combination makes her a likely candidate to get cancer later in life.

Reconstructive surgery after the mastectomy means Boucher appears fine to others – she and her husband, Justin, just got back from a vacation that included lots of swimming in bathing suits – but Boucher knows her days of a double-D cup bra are behind her.

“They’re not as lovely as they used to be,” she said, laughing, in response to a reporter’s fumbling questions about body image. “But it’s way better than cancer.”

Jolie raises awareness

Women such as Boucher have been sharing their stories since Jolie penned an op-ed piece in the New York Times announcing her double mastectomy, surgery that she underwent even though she doesn’t have cancer.

“Many people say, I didn’t even know this test existed. … I think that we’ll see more interest about it now,” said Cindy Arcieri, APRN, director of oncology services at St. Joseph Hospital in Nashua.

The hospital’s Breast Care Center sees some 10,000 women a year, and gives as many as possible a survey about family history designed to spot candidates for genetic testing.

Roughly 5 percent to 10 percent are likely to be such candidates, Arcieri said. The test done on a blood sample or a cheek swab costs around $3,000 and is usually covered by health insurance for women whose history indicates they’re at high risk, minus deductible.

Jolie said she had the surgery even though she doesn’t have cancer largely to make sure she is around as her children grow up. That resonates with Boucher, whose children are 9, 3 and 1.

“I don’t want my kids to see me sick, like I’ve seen my mother,” she said.

At 53, her mother, Julie Hanson, is struggling with ovarian cancer.

Boucher also had an oophorectomy, or removal of the ovaries.

“I want to be there with them, for them,” she said.

Not for everyone

Experts caution that prophylactic surgery – surgery taken to prevent a disease before it occurs – isn’t for everyone, even those who are “BRCA positive.”

Boucher’s surgeon, Dr. Suzanne Coopey, of Southern New Hampshire Medical Center in Nashua, said she performs around 180 breast surgeries a year, about 40 of which are mastectomies, and only one or two are prophylactic surgeries following genetic results with no disease. Even so, the test is often part of the discussion.

Depending on the gene and circumstances, lifetime risk of breast cancer for a woman who is BRCA positive can be as high as 85 percent, while lifetime risk of ovarian cancer – in many ways more dangerous, because it’s much harder to detect at early stages – runs as high as 50 percent.

“We talk a lot about the implications of the test,” Coopey said. “We usually counsel the women to wait until once they’re done child-bearing,” because an oophorectomy +++ often recommended.

“Most women I see have thought about it for many years. They have seen other family members go through breast cancer, ovarian cancer, and oftentimes it’s very easy for the woman to make the decision.”

Drawbacks either way

“The drawback to waiting to have cancer to have surgery is things get complicated with regard to treatment – chemo and radiation therapy,” Coopey said. “It’s much easier to do a prophylactic surgery when you don’t have to worry about doing these other things.”

But the drawbacks of a mastectomy are also obvious, despite huge improvements in post-surgery breast reconstruction.

“We can often save the nipple and areola,” Coopey said. “It’s a cosmetic outcome, but sensation is not the same – and erectile function is completely different.”

Mastectomies are also major surgery. Boucher was on the operating table for 10 hours for the mastectomy, oophorectomy and reconstruction, and in pain for weeks afterward. She couldn’t even hold her child for nine days afterward while she recuperated – although she adds that many women have a much tougher time.

“Everything went well; I was lucky,” she said.

Choosing to forgo surgery

Megan Oliviero, of Bedford, who also has three small children, had the genetic test in 2008. She is positive for BRCA-2, and two of her aunts have died of breast cancer at relatively young ages in the last two years.

Oliviero, 36, hasn’t opted for surgery at this point.

“I am going so frequently to the doctor now, if I had any type of cancer it would be caught at such an early stage that there’s a good chance treatment could be less, perhaps a lumpectomy,” she said.

A complete double mastectomy can’t guarantee cancer-free life, she noted, and extensive surgery can sometimes carry complications.

Oliviero checked off the list of what is often called “surveillance,” including pelvic exams, trans pelvic ultrasound and more frequent doctor visits.

“Every six months, I go see my breast surgeon; we talk about the results of my mammogram, my MRI,” she said.

Reducing risk

Like Boucher, Oliviero takes lifestyle steps to reduce the chance of something in her life triggering the cancer gene – such as eating right, not smoking, exercising.

“I’m a healthy, active, eat-right kind of person,” she said. “Brussels sprouts are my new favorite vegetable – they have wonderful cancer-fighting properties.”

Still, she says, knowing she’s carrying a genetic time bomb is a burden.

“There are those days when I wish I didn’t know,” she said. “But then I look at my children – and I’m thinking about myself as their mother – and if this (knowledge) helps me be there with them, then it’s good.”

Supportive husbands

Both women said their husbands are supportive of their decisions. Oliviero said her husband, Jason, leans more toward her having the surgery than she does, perhaps because he’s an orthopedic surgeon.

Boucher’s husband, Justin, said the choice of whether to have surgery even with no signs of disease struck him as relatively straightforward.

“It’s scary, but, especially seeing her mom go through what she’s going through, I was kind of the one that ended up pushing her: Get it done, get it done!” he said. “I don’t want to sound weird when I’m saying it, but I don’t love her for her boobs – I want to have her around.”

No matter the decision, however, it isn’t easy.

“I really do feel like all women who have to make this choice are brave, no matter what they decide,” Oliviera said.

“There are so many options, it’s incredibly personal.”

David Brooks can be reached at 594-6531 or dbrooks@nashua
telegraph.com. Also, follow Brooks on Twitter (@Telegraph_DaveB).