At age 28, Caitlin, a receptionist living in Queens, faced a daunting decision: Should she have her breasts removed to slash her risk of developing breast cancer down the road? She’d inherited a mutation in the BRCA1 gene that made her much more likely than other women to develop breast and ovarian cancer. The surgery may not be the right choice for all women with this mutation, notes Memorial Sloan Kettering surgeon Mary Gemignani. But for Caitlin, it clearly was.
“Cancer was always an intense worry of mine because it has taken away people who I really loved,” explains Caitlin Brodnick, 28, a receptionist living in Queens who moonlights as a comedian.
“I had this major fear of dying, and these losses were a catalyst for me to focus on being healthy and cancer-free,” she says.
The Value of Genetic Testing
In 2004, Caitlin’s father tested positive for the presence of a genetic mutation — a change in his DNA — that predisposed him to developing certain types of cancer. Together with appropriate counseling, the results of genetic testing can be used to estimate how likely a person is to develop cancer and can help inform decisions about how to manage the risk through screening, medications, or surgery.
When he encouraged his two daughters to get the blood test, one did right away — and tested negative — but Caitlin stalled, agonizing over what she would do if her test turned up positive.
Once she mustered the courage to get the test, the result was hard to swallow: She had inherited a mutation in the BRCA1 gene, which meant she was at significantly increased risk for developing breast as well as ovarian cancer.
“I felt scared and alone,” she shares. “After receiving my test results, I lived in a panicked space for two years, and what I read on the Internet didn’t help. I should have talked to a genetic counselor first.”
Understanding Risk-Reducing Options
Caitlin’s mood lifted and her confidence rose once she met with genetic counselors at Memorial Sloan Kettering’s Clinical Genetics Service, who explained her exact level of risk — a 50 to 85 percent chance of developing breast cancer by age 70 — and what she could do about it moving forward.
Women with a BRCA mutation can choose to have regular screening with mammograms, MRI exams, ultrasound, and clinical breast exams through MSK’s Special Surveillance Breast Program, so that any cancerous changes in their breasts can be detected at an early, more curable stage.
They may also consider taking certain drugs such as tamoxifen and raloxifene, which are effective in lowering the risk of breast cancer for many people. However, doctors caution that the drugs have not been proven to lower cancer risk in BRCA mutation carriers.
“I didn’t want to take a medicine that may or may not help me and then have to deal with side effects,” Caitlin remembers. “I didn’t want to come in every six months to be scanned and worry about whether they would find cancer. And I didn’t want to think about how my parents would cope if I died of this disease. Those options gave me too much anxiety.”
Her Decision: Preventive Surgery
When Caitlin first discovered that she was positive for the BRCA1 mutation, she learned about a surgical option called prophylactic bilateral mastectomy. Her genetic counselors explained that the procedure could reduce her risk of breast cancer by as much as 95 percent. Those struck her as good odds.
“My fear of dying of cancer was affecting my happiness, my security, and my relationship with my husband,” she says. “I also didn’t want to have children before we were ready just so I could breastfeed and then spend the next 15 years feeling resentful because I waited to have the surgery.”
Caitlin met with surgical oncologist Mary Gemignani, who answered her questions about the operation to remove her breasts. She agreed that for Caitlin it was the right choice, especially given her family history of cancer and the age of her relatives at the time of their diagnosis and death.
“But risk-reducing surgery is not right for everyone,” Dr. Gemignani is quick to caution. “Just because someone tests positive for a BRCA mutation doesn’t necessarily mean that they will definitely get breast cancer or must have surgery.”
Realistic Expectations about Breast Reconstruction
Before undergoing the mastectomy in September 2013, Caitlin discussed her breast reconstruction options with plastic surgeon Andrea Pusic. With guidance from the BREAST-Q, a rich database created and overseen by Dr. Pusic and built on the experience of thousands of women who’ve gone through the procedure, she chose the option that best suited her.
“We talked about realistic expectations, outcomes, and her long-term quality of life,” says Dr. Pusic. “Knowing what to expect goes a long way in decreasing anxiety and making you feel comfortable with your choices.”
When she awoke from anesthesia following the mastectomy, Caitlin had already passed through the first step in the reconstruction process, which would continue over the course of several outpatient visits. She also learned that the breast tissue Dr. Gemignani removed during surgery contained no cancer cells. “I had the most incredible feeling of relief that I didn’t have cancer, and I didn’t have that intense worry that I was going to get it,” she says.
Enjoying Life, Cancer-Free
Because she carries a BRCA1 mutation, Caitlin still has a 40 to 60 percent risk of developing ovarian cancer by age 85. She continues to see a gynecologist regularly and may consider having surgery again in the future to reduce her risk for the disease.
But for now, she is focused on enjoying time with her husband and performing stand-up comedy at various nightspots around the city, where her personal journey has been a theme. “Having a sense of humor and talking about my experience has sped up the healing process for me,” says Caitlin.
“Anyone going through this should understand all their options,” she suggests. “Think about your goals and plans and what keeps you up at night. Surround yourself with the smartest people — like the experts at Memorial Sloan Kettering — ask them a hundred questions, and take your time deciding what’s right for you.”