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Voluntary mastectomies to reduce breast cancer risk becoming more common

| Wednesday, May 15, 2013, 12:12 a.m.
This March 8, 2012 file photo shows actress Angelina Jolie at the Women in the World Summit in New York. Jolie wrote an op-ed for the May 14, 2013 New York Times, explaining that in April she finished three months of surgical procedures to remove both breasts as a preventive measure. Jolie says she kept the process private, but is writing about it now with hopes she can help other women.

Actress Angelina Jolie told the world on Tuesday that she prefers life over breasts, announcing a voluntary double mastectomy that dropped her inherited cancer risk from 87 percent to 5 percent.

Women across Western Pennsylvania are way ahead of her.

“We see it more and more every day,” said Dr. Kandace McGuire, director of premenopausal breast-cancer services at Magee-Womens Hospital of UPMC. She said about half of Magee patients diagnosed with a so-called breast-cancer gene defect elect to undergo mastectomies, up at least 50 percent in the past five years.

At Excela Health Westmoreland Hospital in Greensburg, Dr. Rick Payha said he performs double mastectomies for women with the defect — in the genes known as BRCA 1 and 2 — once or twice a month. That's double the volume he did last year, he said.

“Women are becoming more aware of the (genetic) testing that's available, and doctors are becoming more aware of the risk factors that make a woman prone to have a genetic defect,” Payha said. “It's an education process.”

Genetic testing for breast cancer has been available for about a decade, but has become popular only in the past five years, physicians said. They said a blood test costing roughly $3,000 identifies the gene defect, which can raise the lifetime risk of breast cancer to 80 percent or higher.

And while high-profile cases such as Jolie's encourage testing, doctors said, new and better reconstruction methods make breast removal less traumatic.

“Not only do we have the ability to reconstruct the breast, but we can save pretty much all the skin,” McGuire said. “The breast looks essentially the same on the outside.”

Amisha Upadhyay, 30, of Regent Square underwent a voluntary double mastectomy last week and doesn't have a regret, she said. Diagnosed with a BRCA gene mutation, she didn't want to be surprised any more after cancer appeared in one of her breasts when she was 29.

“I did not want to go through that process again,” Upadhyay said. “If I can take a step to take control of this process, I will do that. It's a no-brainer.”

Insurance companies generally provide partial payments for mastectomies and reconstruction for women who face strong genetic odds of breast cancer but have not been diagnosed with the disease, industry representatives said. The federal Affordable Care Act requires insurers to cover genetic screening for women with a known risk factor, such as a family history of breast cancer.

For them especially, Jolie's disclosure is a boon to awareness, said Pat Halpin-Murphy, founder of the nonprofit Pennsylvania Breast Cancer Coalition. Breast removal can reduce their cancer risk to the single digits.

Halpin-Murphy doesn't want the news to panic women unnecessarily. She said BRCA genes are cited in only 5 percent of female breast-cancer cases. The rest appear to have other causes.

“For those women who do have a mother or a grandmother who died of breast cancer, it is important that they talk to their doctor about the possibility of genetic testing,” said Halpin-Murphy, a breast-cancer survivor.

She and her sister did not get genetic tests because they don't have a family history of the disease, she said.

At Allegheny General Hospital in the North Side, Dr. Shivani Duggal said she worries some women will misinterpret Jolie's message and demand blood work regardless of their family histories and other risk factors.

“That would not be ideal,” said Duggal, who works in breast oncology. “These tests are warranted in the high-risk populations.”

Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or asmeltz@tribweb.com.

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