Wednesday, April 16, 2014
PORTLAND – After years of watching family members battle cancer, Denali Wright of Portland faced an emotional decision: whether to undergo testing to learn whether she carried a genetic mutation that put her at extremely high risk for breast and ovarian cancer.
Denali Wright, 33, of Portland, photographed Tuesday, May 14, 2013, underwent a double mastectomy to prevent her chance of being diagnosed with breast cancer.
Actress Angelina Jolie wrote in a New York Times opinion piece Tuesday that she is BRCA-positive and had a preventive double mastectomy. Jolie, whose mother died of ovarian cancer, said she had an 87 percent chance of getting breast cancer, but that risk is now just 5 percent because of the surgery.
In the end, her decision was easy.
"I can't deal with the unknown," Wright said, "so it wasn't really a question in my mind."
She found out that she, like her mother, is among the small number of people nationwide who have the BRCA1 or BRCA2 mutation, which has been linked to hereditary breast and ovarian cancer. With the sobering knowledge that she had an 85 percent risk of developing breast cancer, she chose to have a double mastectomy. She was 31.
On Tuesday, actress Angelina Jolie wrote in a New York Times opinion piece that she is BRCA-positive and had a preventive double mastectomy. Jolie, whose mother died of ovarian cancer, said she had an 87 percent chance of getting breast cancer, but that risk is now just 5 percent because of the surgery.
"Cancer is still a word that strikes fear into people's hearts, producing a deep sense of powerlessness," Jolie wrote. "But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action."
Jolie and Wright are among a growing number of women who are choosing preventive mastectomies to reduce their risk of cancer by as much as 90 percent. The number of women opting for the surgery increased tenfold from 1998 to 2007, according to a study published in 2010 in the Annals of Surgical Oncology.
Doctors in Maine applauded Jolie on Tuesday for her willingness to share her personal decision and for bringing more attention to preventive testing and treatment.
"A lot of women are not aware of their own risk," said Dr. Suzanne Hoekstra, a surgeon with Mercy Hospital's Breast Care Specialists of Maine. "This may help more people take a closer look at their own family history."
Genetic testing can help prevent cancer, but it is not appropriate for every woman, according to doctors.
Only 5 to 10 percent of cancers are hereditary, and only a small number of women get genetic testing to find out whether they carry the gene mutation. The vast majority of cancer cases are sporadic and unconnected to family history, said Dr. Roger Inhorn, medical director of the Oncology/Hematology Center at Mercy Hospital.
The U.S. Preventive Services Task Force recommends that only women with a strong family history of cancer -- just 2 percent of U.S. women -- even think about getting a BRCA genetic test.
Not everyone is a candidate for the testing, said Amanda Lamb, a genetic counselor at the Maine Medical Center Cancer Institute's Cancer Risk and Prevention Clinic. Those who are candidates have increased risk factors, such as:
n Being of Ashkenazi Jewish descent.
n Having multiple close relatives diagnosed with cancer before the age of 50.
n Having male relatives diagnosed with breast cancer.
n Having relatives diagnosed with both ovarian and breast cancer.
The testing -- which costs about $3,000 -- isn't always covered by insurance, Hoekstra said, and that price may prevent some women from getting testing and treatment that would significantly reduce their chances of having cancer later in life.
Doug Dunbar, a spokesman for Maine's Department of Professional and Financial Regulation, which includes the state Bureau of Insurance, said it's unlikely that most health care plans would cover genetic testing or a mastectomy as a preventive measure.
He said genetic testing is usually covered by insurance only if it's used to help plan treatment for a diagnosed condition. And, without breast cancer present, a mastectomy or double mastectomy would likely be considered not medically necessary, and therefore not covered.
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