Easton woman reduces cancer risk with double mastectomy

At 26 years old, Nicole Armstrong faced the decision to keep or lose her breasts.

The choice was hers.

Keep them and live life knowing she had an 87 percent chance of getting breast cancer.

Lose them and fear she''d never look or feel like herself again.

""It was an awful decision,"" Armstrong says. ""A lot of people don''t get a preview of what their lives could be.""

For Armstrong, the cards were laid out in front of her. Her only sister, Catrina, was diagnosed at age 30 with stage-four breast cancer. Nicole Armstrong was there for her sister''s mastectomy, chemotherapy, radiation and brain surgery once the cancer spread. She was there for hospice. In February, Catrina Armstrong died at age 32.

On May 3, Nicole Armstrong, of Easton, went for a prophylactic bilateral mastectomy with direct-to-implant reconstruction, a decision made with the knowledge that both Catrina and Nicole shared a BRCA 1 gene mutation.

Nicole and Catrina Armstrong are among five women to be honored by the nonprofit group Facing Our Risk of Cancer Empowered (FORCE) at a May 31 event in Philadelphia.

Mutation hikes cancer risk

Before her death, Catrina tested positive for the BRCA1 mutation. The BRCA1 and BRCA2 mutations indicate a hereditary predisposition for breast and ovarian cancer. BRCA is a gene that suppresses cancer.

""My parents were told that I should get tested. I was petrified,"" says Nicole Armstrong, a 2003 Easton Area High School graduate. ""I was told at 24 that I had to go and get tested. I wasn''t ready for it."

Catrina, whom Nicole describes as high-functioning despite mental challenges, never complained during her ordeal, even though according to their father, Douglas, the tumor in her armpit was the size of a golf ball when discovered.

""At first it was disbelief that this could happen to her so young,"" Douglas Armstrong says of Catrina. ""Then it turned to anger. How does a 30-year-old get stage-four cancer?""

When Nicole went for the test, Douglas Armstrong says it felt like a death sentence for him and the girls' mother, Melissa.

""It was killer. You want to hope for the best, but you know she had a 50-50 chance of having the gene,"" he says.

Brakes on a car

BRCA is the tumor suppressor gene, explains Dr. Mark Gittleman, a breast surgeon and medical director of Coordinated Health Breast Care Specialists in Allentown. Genes come in pairs - one from each parent -– and everyone has the BRCA gene.

""If you have a normal BRCA gene, it tells cells not to multiply at an above-average rate,"" Gittleman says, likening genes to brakes on a car.

It''s when it mutates that the gene loses its ability to work properly.

According to FORCE, 750,000 people in the U.S. carry a BRCA1 or BRCA2 gene mutation, and their offspring have a 50 percent chance of inheriting it.

"The mutation in BRCA genes are passed from families," says Dr. Lee Riley, St. Luke''s Medical Director of Oncology.

Typically it''s just one bad copy of a gene that puts a patient at risk. But just a bad copy doesn''t immediately signal cancer.

""You still need another mutation to occur to actually get cancer,"" Riley says.

Not all breast cancer is a result of a mutated BRCA gene. About 5 percent of breast cancer patients have a BRCA mutation, he says.

""Just because you have a BRCA mutation doesn''t mean you''ll get cancer,"" Riley says.

BRCA increases the risk of cancer by 50 to 85 percent, Gittleman adds.

Her choice

In April, Nicole Armstrong hosted a "goodbye boobie" party. There was a cake, a toast for guests and breasts, and a shirt for visitors to sign that Nicole would wear to the hospital for her surgery.

Fears of feeling uncomfortable in her own body and losing a shred of identity were dwarfed by what lay ahead for her.

"At 26 years old, I didn''t want to have the image of me distorted for the rest of my life," Nicole said." As her sister battled cancer, Nicole says she hid behind her and ""once she passed away, I didn''t have that shield.""

Without the double mastectomy, mammograms or breast MRIs would have been routine for Nicole every six months. In between those visits, she''d be expected to get breast exams from her gynecologist and oncologist, in addition to an annual ovarian cancer test. Only a few years out from when her sister was diagnosed, she went forward with the surgery.

Now a few weeks from her surgery, Nicole says everything looks pretty great, though she has some shopping to do.

""I know ultimately I did the right thing,"" Nicole Armstrong says. ""I went from an 87 percent risk down to 3 percent.""

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Mother link to breast cancer 'an old wives' tale'

For Nicole and Catrina Armstrong, the gene mutation that sharply increased their cancer risk came from their father's side of the family. A paternal grandmother died at 45 from breast cancer.

""A lot of people think breast cancer only comes from your mother -- –that''s an old wives'' tale,"" Nicole Armstrong says. ""We always knew there was a higher risk, but we knew nothing of the BRCA1.""

A genetic counselor helped them determine the risk and appropriate testing.

The BRCA test involves either blood sent to a lab or spitting in a cup to examine DNA, says Dr. Mark Gittleman, a breast surgeon and medical director of Coordinated Health Breast Care Specialists in Allentown.

Should all people be tested for the gene mutation? ""No,"" says Gittleman.

Since only 5 percent of breast cancer is associated with the BRCA gene mutation, it''s important to understand the increased risk factors before being tested.

Insurance may not cover testing unless significant risk factors are identified. If a patient has a strong family history -- say, for instance, their mother, sister and aunt had it, or had cancer in both breasts -- they might be candidates.

Dr. Lee Riley, medical director of oncology for St. Luke''s Hospital, adds that other red flags are someone in the family with breast cancer under age 50 (when the average age is about 65), the number of first-degree relatives that developed cancer, breast cancer in a male family member, or a history of ovarian cancer.

St. Luke''s has an information line, 484-503-HOPE, that patients can call with questions. Callers can be directed to a trained team at the the St. Luke's Anderson Cancer Center.

Those concerned because they have family with breast cancer or ovarian cancer should talk to a genetic counselor or cancer specialist to see if they should undergo testing," Gittleman says.

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IF YOU GO

Facing Our Risk of Cancer Empowered (FORCE) has teamed with University of Pennsylvania''s Abramson Cancer Center for a May 31 event.

It is open to the public and will feature a screening of the Lifetime movie ""Five,"" directed by Jennifer Aniston, Demi Moore and Alicia Keys. The Armstrong sisters, of Easton, are among five women to be honored throughout the night, from 6:30 to 9 p.m. at the Translational Research Center, 3400 Civic Center Blvd., Philadelphia.

Guests are asked to RSVP at facingourrisk.org/RSVPPhila. The venue seats 200, and fewer than 20 seats remain, says Stacey Jacobson, outreach coordinator for the Philadelphia chapter of FORCE.

The nonprofit group is dedicated to helping those affected by hereditary breast and ovarian cancer," Jacobson says.

The event, support groups throughout the year, an annual conference and fundraisers aim to raise awareness.

""Once people start to find out, they can start taking risk-reducing measures,"" Jacobson says.