Why this 28-year-old P.E.I. woman chose to have a double mastectomy

Last week, 28-year-old Hannah Gehrels of Charlottetown said goodbye to her breasts. 

It was with mixed feelings, she said, but in the end the decision was simple: having them removed could save her life.

"This definitely felt like the right decision for me, even though it's hard in some ways," Gehrels said just a few days after her surgery at the Queen Elizabeth Hospital in Charlottetown.

"Different layers in there in terms of how it feels … physically, emotionally and mentally." 

Gehrels had discovered the BRCA2 gene was prevalent in her family and that family members had tested positive for it, which meant she may have inherited the gene as well. 

Studies show that those with inherited BRCA1 or BRCA2 gene mutations have up to an 85 per cent chance of developing breast cancer in their lifetime, a higher risk of developing breast cancer at a younger age, and a higher risk of developing cancer in both breasts, according to the Canadian Cancer Society. They're also predisposed to other kinds of cancer including ovarian, pancreatic, melanoma or skin, and prostate cancer.

"It took me a couple years to decide to get tested — I wasn't sure I wanted to know, at first," she said. "But then eventually, I felt ready."

'Not the news you're hoping for'

Finding out she did have the mutation was difficult, she said, but being able to get the test and actually take measures to prevent cancer was "a pretty incredible thing."

"It was hard, as you can imagine. It's not the news you're hoping for," Gehrels said. "But then with the information, I immediately learned about what my options are. It was pretty great to pair that information with what I can do about it." 

Gehrels said she was given a couple of options after testing positive: she could have a preventive double mastectomy, or she could be screened every six months with a mammogram or MRI. 

According to the Canadian Cancer Society, a prophylactic mastectomy results in about a 90 per cent decrease in the risk for breast cancer in high-risk women.

"Once I found out I was positive [for the gene mutation], I knew that I wanted to have preventative surgery," she said.

"I have no desire, risking it for the chance of getting breast cancer."

'The best protection'

Kelly Metcalfe, a scientist at Women's College Hospital in Toronto, focuses her research on the prevention and treatment of hereditary breast cancer. She has developed a decision-support tool for people with the BRCA1 and 2 mutation to help them assess their breast cancer prevention choices, and counsels women in their options.

"These women are faced with very difficult decisions … about what they're now going to do with their risk in terms of preventing these cancers they know they are at a very high risk of developing," Metcalfe said.  

Where breast cancer patients who have not tested positive for the mutation are offered a lumpectomy and radiation, that's not enough for those with BRCA1 or 2, Metcalfe said — the more aggressive surgery of removing both breasts is recommended.

Metcalfe confirms while mastectomy versus vigilant monitoring is "an individual choice," she calls surgery "the best option" — because a double mastectomy is the best way to all but eliminate the chance of breast cancer in BRCA patients. 

"That doesn't bring her risk down to zero, because there are documented cases of a woman being diagnosed with breast cancer after she's had a double mastectomy, but it's very, very, very rare," she said. "It is the option that will offer a woman the best protection that she will never get breast cancer."

According to Metcalfe, in Canada 30 per cent of these patients choose double mastectomies. Metcalfe said often they are younger women, sometimes with children, who want the best chance of survival and living a long life. Sometimes they are women who have watched a close relative like a mother suffer with or die from breast cancer.

'Felt right to me'

Some people have asked Gehrels why she wanted to have the surgery when she is so young. Why not wait a few years?

"I knew even without breasts I can still have kids, if that's something I choose in the future," she said. "It's what felt right to me."

She said the recovery time for her surgery is about a month and she's got a strong system of friends, family and a partner who are supporting her through the health-care journey.

'Won't have to wear a bra ever again'

Gehrels said she is part of the queer community, and loves seeing diversity in bodies — in their sizes and gender presentations.

You can feel beautiful in the body that feels good to you and that works for you.— Hannah Gehrels

"I like to celebrate anything that's outside of the norm of what mainstream society enforces," she said. "I'm now a woman without breasts, and I think that's pretty neat.

"There's definitely aspects of having a flat chest that I'm really excited about.… I won't have to wear a bra ever again, which is a plus for me."

None of that means it was easy to say goodbye to her breasts, and her body as she has known it for years. She said she had before photos taken professionally, so she could remember how she looked, and is considering getting after photos taken too. Although her new body is something she said she will have to get used to, she feels no less a woman.

"Certain parts of our body don't determine our gender in any way," she said.

"You can feel beautiful in the body that feels good to you and that works for you," Gehrels said, adding she does not plan to have reconstructive surgery. 

Gehrels is bucking a trend in that regard. Metcalfe said 90 to 95 per cent of women choose to have reconstructive surgery at the same time as mastectomies.

Gehrels is still thinking about the other kinds of cancer to which the BRCA2 gene mutation predisposes her.

Some people with BRCA mutations opt to get their ovaries removed, which according to the Canadian Cancer Society can lower the risk of both breast and ovarian cancers, but some women may decide to wait until after they've finished having children.

Gehrels said she is also going to see a skin specialist to keep an eye on her melanoma risk. 

She said she is happy to share her experience with any Islanders who are considering being tested for the gene.

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