Preventative surgery: Is it for you?

At 17 she found the first lump in her breast and had it removed.

Then four more lumps were removed one by one.

In 2007, when yet another benign lump appeared on her breast, Vanes Ryerson of Henderson had had enough. Both her mother and grandmother had dealt with breast cancer, and Ryerson was ready for a preventative double mastectomy.

"I didn't want to continue having lumps removed," she said. "I wanted to have peace of mind that I would be clear of the possibility of ever having breast cancer."

While Ryerson skipped the common step of genetic testing and had a preventative double mastectomy without knowing if she carried the genetic mutation associated with breast cancer, the testing is becoming common practice for women who have a family history of breast and ovarian cancers.

"I've often been told I was crazy for being so radical without even knowing if I actually was a carrier of the cancer cells," Ryerson said. "I've also been told I was brave. I think the right description is educated peace."

Genetic testing for the BRCA 1 and BRCA 2 genetic mutations is done on most patients who meet certain criteria set by the National Cancer Consortium, including being diagnosed at age 45 or younger, having a female relative diagnosed under the age of 50, being of Jewish heritage or having a relative with ovarian cancer.

"Nowadays almost all ovarian cancer patients are getting the genetic testing," said Dr. Josette Spotts, a breast surgeon with Comprehensive Cancer Centers of Nevada.

The genetic testing can be performed by either blood test or administered via a solution the patient swishes in her mouth and then spits into a container. The $4,000 test is usually covered by insurance for patients who meet the national criteria.

"Genetic testing exploded when Angelina Jolie went public," said Dr. Mary Ann Allison, an oncologist with CCCN. "She's the Betty Ford of breast cancer."

Spotts noted that as more gynecologists are taking a more thorough family history, more patients are being urged to have genetic testing.

Patients who test positive for the mutation carrier have a lifetime risk of 85 percent for breast cancer and about 45 percent for ovarian cancer, according to Spotts.

She warned, though, that those rates were based on initial studies and said that as more patients are tested for the genetic mutation and a larger sample is generated, the field may see a decline in those risk rates.

After the testing is when bigger decisions must be made.

"If a patient knows she carries this, she may decide to have preventative surgery," Spotts said.

Women who test positive need to have a conversation about preventative double mastectomies and about the removal of ovaries.

Allison suggests women who test positive should have the surgeries done before the age of 40 to reduce the potential for cancer but is cautious to note that there is a psychological aspect to the surgery as well.

"It's not just a medical diagnosis. It's a life-changing event," Allison said.

Spotts says that some women choose not to have the surgery or to wait. In those cases, the patient should alternate mammograms and MRIs every six months.

She says women who tested positive for the mutation and have high anxiety about the potential for cancer should get the surgery.

"Every patient is different," Spotts said. "I tell them the risks involved. It's a big surgery."

In the end, a preventative double mastectomy reduces a woman's risk of breast cancer to 3 percent, according to Spotts. And, if performed before menopause, removing the ovaries reduces the risk of breast cancer by 50 percent.

"I know many women who have done any and everything to save their breasts," Ryerson said. "I commend them. I, however, chose to be radical in my decision and am extremely confident that I did the best thing for me."

Advances in reconstructive surgery allow patients to spare the nipple. Spotts recommends patients go this route but warns it's simply cosmetic and often there is no sensation at the nipple.

"I would always tell ladies to ask questions, listen to doctors, but to mostly trust their instincts," Ryerson said. "I encourage my daughter, who is 19, to do self-exams, because I want her to be aware of the risks and possibility that she may or may not have the same decision in her life."