Even though I had my mastectomy and reconstruction done in a one step procedure, it still was really just the first step of a bigger process to reduce my cancer risks. Unfortunately having a BRCA mutation increases your risk for not just breast cancer, but also ovarian, colo-rectal, melanoma, prostate, stomach, and uterine cancers. Now that my breast cancer risks have been reduced/almost eliminated, my next biggest risk is ovarian cancer, The general population has a lifetime risk of about 1 in 70 (1.5%) of developing ovarian cancers. Those with BRCA1 mutations have about a 40% lifetime risk.
Honestly, I wasn't really concerned by this risk at first. We don't have the huge family history of ovarian cancer. But the more I learned and researched about reducing my breast cancer risk, the more I saw the connection between breast and ovarian cancers. All of the recommendations that I've received from multiple doctors state not just a recommendation to remove my breast tissue, but also to remove my ovaries.
This is more than I'm willing to do right now. I put all the fight that I have into this mastectomy and reconstruction and want some time to just be normal for awhile. I understand why doctors recommend it. If breast cancer is fueled by estrogen, removing the ovaries will almost completely eliminate the estrogen in you and further decrease breast cancer risk while eliminating ovarian cancer risks at the same time. However this surgery has major physical and psychological side effects. This is not something I'm ready for yet. Maybe down the road...but definitely not now. I even said to Mitch the other day that I've worked so hard to not get breast cancer, I don't want to deal with ovarian cancer too. If I were to get it without any family history, then maybe that's just how things are supposed to be. He quickly pointed out that this doesn't match with my opinions on breast cancer and challenge me on it. I love him for this. I can't stick my head in the stand and ignore my other risks. I did this so that I can be here for my children and grandchildren; I cannot be done yet.
So Friday morning, I had my first consultation with a gynecological oncologist to find out what I can do in the mean time to monitor and reduces my risks for ovarian cancer. I knew a little bit going into it, but it felt great to hear his recommendations. He wanted to send me down for some tests right away that day. All of the recommendations say to start these tests at 30. I'm thrilled that he didn't say because I'm 29 right now, we can wait 6 months. This showed me that's he about action, not sitting around waiting for cancer to grow. He is going to order a blood test called CA125 every 3 months, rather than the 6 month recommendation. He outlined exactly what we're looking for with the blood test, what would happen if there begins to be an unhealthy pattern (additional ultrasound of ovaries), and what our nonsurgical option are (OVA1 test if any mass were to be found).
The number 1 thing I can do to reduce my risks is surprisingly using oral contraceptives, something I had been avoiding for years because of the increase in breast cancer risk associated with hormonal birth control. It was interesting to find out that not all birth control options provide reduced risk for ovarian cancers. Now that I do not have breast tissue, this sounds fine by me providing they don't make me crazy or have any additional strange side effects.
When we feel 100% sure that our family is complete, having a tubal ligation would provide additional benefits. He'd like to take it one step further and completely remove my fallopian tubes as new studies show that most ovarian cancers are originating in fallopian tubes, then spread to ovaries. This is an exciting option to me. It would allow me to retain my ovaries, so that I don't have to go through chemical menopause at a young age. Then when I get closer to natural menopause age, I can remove my ovaries to give me the extra protection from both breast and ovarian cancer as these risks increase with age.
I left that appointment feeling great. I think I just found the Dr. Colette of Gynecology!