Feature

The Time-Bomb Genes

She shopped for doctors in earnest and stuck to a rigid set of standards. If there was a nurse in the office who was snarky, or anything else at all she didn't like about the practice, it was eliminated. She talked to other women who'd had their breasts removed. "I was empowered. I knew what I was looking for, I had time, and I felt I was in control of this disease. If I had been diagnosed first, I don't know if I would have, if I could have, taken so much time. If I'd been frightened, perhaps I would have dealt with the first guy who was looking to help me. I might have allowed some hysterical doctor to perform the surgery. But now I was in control. I chose to lose my breasts. The cancer did not decide that for me."

The turning point for Angela came when she went to see Dr. Alexandra Heerdt, who heads Sloan-Kettering's high-risk program for women. Heerdt was patient, informed, and compassionate. But she was also direct. She told Angela that based on her family pedigree, her BRCA status, and film of her breasts, she believed she had an extremely high risk of getting cancer.

After their meeting, Angela sat down next to her husband, who'd gone with her, on the commuter train to go home. They hadn't said much to one another since they'd left the doctor's office, and now when she looked at him, he knew what she was about to say. "It's a go," she told him. "I've found my surgeon."

Angela then chose a plastic surgeon based on recommendations and one interview, and by the time she met with him, she already knew which of the available reconstruction options she wanted. She decided on saline implants. At the end of the surgery, a temporary device called an expander would be put in her chest and filled with saline in order to gradually stretch the skin to accommodate new breasts.

Angela knew when she left the hospital she'd have small breast mounds without nipples. Each week a little more saline would be added to the expander until she had breasts the size she wanted. Then, in a second surgery, the expander would be removed and the permanent implants put in. In a third procedure, some skin would be taken from her groin to construct a nipple and an areola. Finally, micro-pigmentation would add color to the areola that would hide some of the scarring. The entire four-step process would take about a year.

But before the surgery was scheduled, Angela had to meet with a psychologist and answer some questions. How would her life be different if her breasts were removed? How did her husband feel about this? What interests did the two of them pursue? How would this affect their sex life? What did her sons think?

"My husband was actually more concerned with how this would affect me. And with my family history, these breasts were not thought of as sex objects. I didn't have the same affinity for my breasts that another woman might have. They were the things that could end my life."

Nine days after the surgery, when Angela was in the very early stages of physical and emotional recovery, a biopsy report came back. It revealed she had an intraductal carcinoma -- the very beginnings of breast cancer.

"I don't know if my recovery would have been any different if the pathology had come back negative," Angela says now, thirteen months after the ordeal. "But I feel I made all the right decisions for all the right reasons, and as a result I sleep very well at night. I believe genetic testing saved my life."