As the Breast Cancer Risk Increases With Age, Some Women Are Opting for Breast Reconstruction

Evelyn Tigwell, 52, was very aware of breast cancer. 

After her sister was diagnosed with the disease in 2018, Tigwell, her siblings and her mother were all found to have the BRAC2 genetic mutation that increases the risk of developing breast cancer to 70 per cent or greater.

Despite being eligible for enhanced screening, including regular MRIs because of her genetic mutation, Tigwell was unwilling to live with the escalated risk of becoming one in eight Canadian women who will be diagnosed with breast cancer in her lifetime. 

“It was not a good mental choice for me to go through every year,” she explained.

Instead, she decided to have a prophylactic double mastectomy and breast reconstruction, just as actress Angelina Jolie had done in 2013.

This month, Breast Cancer Awareness Month, Tigwell wants to share her experience to support other women with the genetic anomaly and those opting for breast reconstruction.

“I saw what my sister went through and I knew that if I developed breast cancer, I would choose right away to do a full bi-lateral mastectomy,” she says. “So I decided it’d be better to do that now while I’m healthy and the recovery would be easier.”

Making that choice reduced Tigwell’s risk of breast cancer from 70 per cent or greater to 5 per cent. The lingering slight risk is due to a small amount of breast tissue that remains after surgery.

“The national risk average is 12 per cent,” notes Tigwell, a high school guidance counsellor who lives near Barrie, Ont. “So I decreased my odds considerably.”

Tigwell underwent radical surgery and breast reconstruction in 2019 to dramatically lower her risk of becoming one of the 78 Canadian women who will be diagnosed with breast cancer every day in Canada in 2022.

Each one of the 28,600 women who receive that diagnosis this year has their own story.

And many thousands more are faced with the prospect of the disease when they go for genetic testing or for the biannual mammograms that are recommended for most women in Ontario from age 50 to 74.

The spectre of breast cancer looms for all women as we age.

In women ages 40 to 50, there is a one in 69 risk of developing breast cancer. From ages 50 to 60, that risk increases to one in 43. In the 60 to 70 age group, the risk is one in 29. And in women ages 70 and older, one in 26 is at risk of developing the disease.

 

New Therapies

 

But just as the risk increases for women every year as they age, so does the research leading to new treatments.

Just in the past year, since Breast Cancer Month 2021, new therapies were approved in Canada for breast cancer.

In April, Health Canada approved Keytruda (pembrolizumab) as a treatment for high-risk, early-stage triple negative breast cancer in combination with chemotherapy.

In June,  Health Canada approved Enhertu (trastuzumab deruxtecan) for patients with inoperable or metastatic HER2-positive breast cancer who have received at least one prior anti-HER2-based regimen and developed disease recurrence. 

About 10 per cent of newly diagnosed breast cancers in Canada are metastatic, and for those initially diagnosed with early-stage breast cancer, approximately 30 per cent will progress to metastatic disease. HER2-positive breast cancer tends to be a more aggressive sub-type of breast cancer, comprising about one in five cases.

Evelyn Tigwell was familiar with all the statistics when she decided to take control of her body and having her breasts removed.

The operation, which required two surgeons working at each side of her body, took four hours, including the mastectomy and the reconstruction.

The procedure was done on an out-patient basis. “That night,” Tigwell recalls, “I slept on the couch.”

Although she experienced “a very good physical recovery,” she says, “it took me a while to be able to look down at my body and see all the bruising and scabbing. I looked beaten up. That was hard for me, so my husband would check the sites, checking for infection.”

Tigwell was not a candidate for using her own tissue in the reconstruction process, which is a more complex surgery, and silicone implants were used instead.

“In winter, they can feel quite chilly,” she says. “There was some feeling lost from the surgery as well. I don’t have the same sensation in and around my breasts. I’ve lost a nipple on one side. 

“Also, because they’re implants, I know they have a shelf life and may have to be replaced.”

As well, she explains, “When I lie on my stomach, it does feel like I’m lying on tennis balls.” 

Nevertheless, Tigwell feels “100 per cent” positive about her decision, with no regrets.

“She acknowledges that the experience could be very different for women whose mastectomies followed by reconstruction were a consequence of cancer.

“It was my choice,” she explains. “I was in control and that put me in a different mindset. It was a positive for me because I was reducing the risk.”

She adds, “I would make the same choice again.”

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