MARQUETTE - Bonnie Kilpela was only 14 when her mother died of breast cancer. Knowing the pain of losing her mother at such a young age and knowing she had a high risk of getting breast cancer herself due to family history, Kilpela made the difficult decision four years ago to undergo bilateral prophylactic mastectomies at Marquette General Hospital.
The preemptive surgery involves removing both breasts and, if the patient chooses, replacing the tissue with implants. Studies have shown the procedure reduces the risk of getting breast cancer by 90 percent in moderate and high risk women.
People who have the surgery are usually at high risk of breast cancer. However, being identified as high risk does not mean a person will get breast cancer, it just means the chance of developing breast cancer is several times higher than that of an average-risk woman.
An image that was created for the cover of the “My Pink Warrior 2010” calendar that mostly features area women who suffered from breast cancer. (Wendy Hill Manson photo)
Kilpela, a physician's assistant, said she weighed the decision in her mind for seven years, putting it off until after she had children.
"It was a hard decision. You're scared. It's a big surgery," she said.
"I was 9 when my mother got cancer and 14 when she died. That's a very influential time," she said. "All her care was at Mayo Clinic and my dad would drive her there. One time they were there for 30 days in a row and my dad would drive back on the weekends so we could see our mother. And that's an eight hour drive from Escanaba. He's a potato farmer. He's not rich. He did everything he could for my mother to try and save her life."
Both Kilpela's sisters have had the procedure as well as her aunt Bernice, who was inspired to have the surgery following Kilpela's involvement in the Pink Warriors calendar, which features breast cancer survivors from the Marquette area.
"One of my aunts had seen the calendar and because of the calendar she asked me privately about having reconstruction done. She's 70 years of age and she had breast cancer 26 years ago," Kilpela said.
When surgeons went in to do the surgery, they found cancer, which they then removed.
"Every time she's seen me since then she just cries and hugs me ... she called my dad to tell him that she's all healed and everything and she feels like I'm her guardian angel. Which of course I'm not, but God works in very amazing ways and I think he's the one who guided her to seeing the calendar," she said.
People may want to consider the surgery if they: already had cancer in one breast, a family history of breast cancer - especially if that family member was diagnosed before age 50, positive results from gene testing, early signs of cancer such as precancerous or abnormal cells in the milk-producing glands of the breasts and other factors.
Gene testing looks for harmful mutations in the BRCA1 and BRCA2 genes. In normal cells, the genes help stabilize the cell's genetic material and prevent uncontrolled cell growth. Mutation of these genes has been linked to the development of hereditary breast and ovarian cancer.
According to the National Cancer Institute, about 12 percent of women in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women who have inherited a harmful mutation of BRCA1 or BRCA2.
Gene testing can be expensive. It may cost several hundred to several thousands dollars and not all insurance policies cover the costs.
There are more common ways to decrease the risk of breast cancer, such as eating a healthy diet low in fat and high in fiber, fruits and vegetables; exercising regularly and not smoking and reducing alcohol consumption.
Foods high in vitamin d help, such as oily fish, margarine, butter and eggs. Spending a limited amount of time in the sun also helps with vitamin D. Red meats, fast foods and greasy foods should be avoided.
It's also important to exercise regularly. One recent study showed that postmenopausal women who did brisk walking one hour every day cut down the risk of breast cancer by 16 percent. The American Cancer Society recommends 45 to 60 minutes of exercise five days a week.
Smoking and drinking alcohol increases the risk of breast cancer. Smoking, which increases the chance of heart disease as well as other cancers, depletes folic acid which helps prevent cancer.
A healthy lifestyle helped reduce the risk of breast cancer for women with and without a late-onset family history. Of women who followed healthy guidelines, about six of every 1,000 got breast cancer, according to a recent study. In comparison, about seven of every 1,000 women developed breast cancer if they had a late-onset family history and followed none of the healthy behaviors.
"You may say that's only one more person out of 1,000 but that's huge if you're that person that gets diagnosed with breast cancer," Kilpela said.
Women without a family history of breast cancer should should have annual mammograms starting at age 40. Women with a family history should consult their physician.
"Since 1990 when we first started doing annual screening, mammograms, there has been a decrease in mortality from breast cancer by 30 percent for all ages," Kilpela said.
Christopher Diem can be reached at 906-228-2500, ext. 242. His e-mail address is firstname.lastname@example.org.