Racing Against BRCA: Bonus Clip #3 - Proactive or Reactive

Proactive or Reactive-
You have two... well, three options if you find out you have the BRCA genetic mutation. 

1. Proactive with prophylactic mastectomy, oophorectomy, and hysterectomy:

a. Prophylactic mastectomy is surgery to remove one or both breasts to reduce the risk of developing breast cancer. According to the National Cancer Institute, prophylactic mastectomy in women who carry a BRCA1 or BRCA2 gene mutation may be able to reduce the risk of developing breast cancer by 95%.

b. Prophylactic salpingo-oophorectomy is the complete surgical removal of the ovaries and fallopian tubes for the prevention of cancer. 

c. Prophylactic hysterectomy is the removal of the full uterus. With the full hysterectomy, hormone replacement therapy will most likely be needed, as it will send you into menopause. 

2. Reactive: High risk screening, which includes a surveillance protocol w/ mammogram, MRI, and ultrasound, if they find something with these tests, then you take steps. What a lot of people don't realize is that this is the decision more women make, because it's not talked about it quite as much as the prophylactic surgeries.

a. Mammogram: is an x-ray picture of the breast, where they smash your boobie into a pancake. You will likely have a breast ultrasound at this time as well if you're under surveillance by your gynecologist.

b. Ultrasound: An ultrasound works using sound waves and is more comfortable than a mammogram.  The breast ultrasound’s main advantage over mammograms is that it’s very good at showing whether a lump or mass is solid, or filled with fluid. A solid lump needs further examination— either via MRI or biopsy. But if the lump is filled with fluid, your testing is done— this type of lump is a cyst. A transvaginal is the most fun (not) and a probe is used to go up into your vagina and it looks like a dildo, but it's not (obvi). This is used to look at the uterus, ovaries, tubes, cervix and pelvic area. Pelvic ultrasound is done externally, in between your pelvic (hip) bones. For this, you have to have a full bladder, because it's used as a window to view your internal organs, including the ovaries, uterus and cervix. Try to not pee the table with this one!

c. MRI:  of the breast (or breast MRI) is a test used to detect breast cancer and other abnormalities in the breast. A breast MRI captures multiple images of your breast which are combined using a computer to generate detailed pictures. They sometimes put you in weird positions for this test. My mom said where she gets it done, they make her kneel and when I had it done, I was on my side. 

3. Denial: I will never tell anyone what to do...except for right now. DO NOT go into denial when you know you have this gene. Whichever route you choose, whether it be, proactive with surgery or reactive with surveillance. Just because you ignore this gene does not make it go away. Ignorance and NOT bliss and knowledge IS power! If you are having a hard time deciding which step to take and don't know which is right for you and you want to talk to a real person and not a doctor, I am here. 

Bottom line is, this is a really complicated decision and there are no good options. People will always be quick to judge you, no matter what your decision is. Every woman facing this decision is brave, no matter if you choose to be proactive or reactive. If you are having trouble figuring out which decision to choose, find an oncologist and talk about your personal risks (everyone is different) and if you want some further insight you can always DM me or comment. I am always happy to give you more of my personal journey. 

All the love,

Caroline Plank