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Christina Applegate's Mastectomy: FAQ

Breast Cancer Survivor Christina Applegate Opts for Preventive Double Mastectomy and Breast Reconstructive Surgery
By
WebMD Health News
Reviewed by Louise Chang, MD

Applegate Mastectomy FAQ

Aug. 20, 2008 -- Actress Christina Applegate recently had both breasts removed in an effort to prevent her breast cancer from returning and said that she will get breast reconstruction.

Applegate, 36, star of the ABC comedy Samantha Who?, announced her breast cancer diagnosis earlier this month. Yesterday, she told ABC's Good Morning America that she is now "absolutely, 100% clean and clear" of cancer.

Before getting her preventive (prophylactic) double mastectomy three and half weeks ago, Applegate had two lumpectomies -- and only had cancer in one breast, according to Good Morning America -- and took a gene test that showed that she had the BRCA1 gene mutation, which makes breast cancer and ovarian cancer more likely.

Applegate called her mastectomy decision "tough" but the "most logical" possibility for her. She said she based her choice on her family history -- her mother has had breast cancer and cervical cancer -- and her BRCA1 gene.

Is Applegate's approach to breast cancer one that would work for other breast cancer patients? And what will the reconstruction process -- for Applegate and for other women -- be like?

WebMD talked with four doctors -- and with a breast cancer survivor who made some of the same choices that Applegate did -- about preventive mastectomy and breast reconstructive surgery. None of the doctors who talked to WebMD are treating Applegate.

Did Applegate make a good choice?

"I think she did the absolute right thing, and she did it the right way," says Jay Brooks, MD, FACP, chief of hematology/oncology and chief of staff at the Ochsner Health System in Baton Rouge, La.

"She underwent lumpectomy and then, when she got the information back from the genetic testing, she was able to have a little time to discern what this all meant and then she went forward to have the prophylactic mastectomies, which are clearly the best treatment to reduce her risk of ever developing breast cancer [again] by at least 90%," says Brooks.

"I think that's a very reasonable approach," says Brooks. "It may not be right for every patient, but I think especially if you have this genetic mutation -- it's such a highly active mutation in terms of increasing the risk of breast cancer -- that it's certainly something that I would recommend to one of my family members or to my patients, and I do," says Brooks, noting that only about 5% to 7% of breast cancer patients have cases similar to Applegate's.

"Because her risk of an additional breast cancer is extremely high, in the range of one in two, why take a chance?" asks Eli Avisar, MD, breast cancer surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

Gisella Alvarez, RNC, is a nurse at Mercy Medical Center. Two years ago, at age 44, Alvarez learned she had stage I breast cancer in one breast. She decided to have both breasts removed and get breast reconstruction. Her case wasn't exactly like Applegate's -- Alvarez had an elderly aunt who had had breast cancer but she hadn't had the BRCA gene test -- but she took a similar approach.

Alvarez says Applegate's decision was "brave" and "smart because life is too short. It's not worth living your life worrying every six months when you have to go back for tests and more tests -- and hoping that it's not going to come back. With this way, you really increase your chances of not having to worry about it again and live your life."

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