When Lisa Schlager took part in a research study in 1999, she never expected to get some news that would change her life forever.
In the course of the study, Schlager tested positive for a BRCA gene mutation, an abnormality known to increase greatly the risk of developing breast and ovarian cancer. A women with a BRCA mutation is about five times more likely to develop breast cancer and 10 to 30 times more likely to develop ovarian cancer than women who don't have a mutation, according to the National Cancer Institute.
She didn't know much about the breast cancer gene at the time. But when she discussed the results with her doctor, she learned how serious it was.
"I told her I was BRCA-positive and she said, 'So when are we scheduling the surgery [mastectomy]?'" said Schlager, who lives outside Washington, D.C.
"I was like, 'I don't have cancer. I'm not going to have surgery.'"
Schlager, now 43, refused for several years to have a mastectomy and went on with her life. She had two children and started her career in marketing communications.
But after some abnormalities were found during routine breast-cancer screening, she started to worry not about if she would get cancer, but when she would get it.
She finally decided in 2007 to go along with the medical recommendation that women who have the BRCA mutation and are older than 35 who are done bearing children have their ovaries removed.
She said her desire to start hormone replacement therapy to help alleviate menopausal symptoms played a part in her decision, as her doctors wouldn't agree to it before the breast-removing surgery because of the risk associated with the BRCA mutation.
"I asked about having my breasts removed, and they said it's OK to do HRT [hormone replacement therapy] after they're removed," she said.
After that, Schlager decided to have her ovaries removed in 2007, followed by both of her breasts in 2008.
Schlager's decision, albeit a difficult one, could well have lengthened her life, according to the results of a study published in the latest issue of the Journal of the American Medical Association.
Researchers found that having a preventive mastectomy may reduce the risk of breast cancer in women with BRCA 1 and BRCA 2 mutations. They also discovered that preventively removing both the Fallopian tubes and ovaries -- a procedure called a salpingo-oophorectomy -- was associated with a lower risk of ovarian cancer, a lower risk of breast cancer in women who were never diagnosed with it before as well as associated with a lower rate of early death from any cause, mortality from breast cancer and mortality from ovarian cancer.
In women with a previous breast cancer diagnoses, however, salpingo-oophorectomy was not associated with a decreased risk of developing ovarian cancer.
While doctors have known for some time that preemptive surgery in women at high risk of these cancers reduces their risk of the diseases, the recent study revealed the potential life-extending nature of salpingo-oophorectomies.
"It is important to reaffirm other existing data showing the benefits of prophylactic surgery in this high-risk population," said Dr. Kathy J. Helzlsouer, director of the Prevention and Research Center at Mercy Medical Center in Baltimore.