Giuliana Rancic's Upcoming Mastectomy: What's Next?
PEOPLE spoke with three breast cancer experts about what Rancic, 37, and other breast cancer patients in their childbearing years can expect from this radical course of treatment.
Dr. Elizabeth Chabner Thompson, a radiation oncologist who has devoted her career to treating women with breast cancer, says that a decision like Rancic's would make sense for that particular circumstance.
"Mastectomy and reconstruction could be an easier path for her," says Thompson. There is a higher risk of breast cancer recurrence for women who choose lumpectomy and radiation (since breast tissue remains after those procedures) over mastectomy patients (where the breast tissue is removed). But overall survival rates are about the same, adds Thompson.
"A young mother doesn't want to have to worry about getting cancer again," says the oncologist. "I think she was smart to make the decisions that she did." Rancic – who previously underwent a double lumpectomy – said herself of the mastectomy option: "All it came down to was just choosing to live, and not looking over my shoulder for the rest of my life."
What sort of recovery time will she face – and what does breast cancer mean for other women who want to have children? Dr. Thomspon weighed in, along with registered nurse and author Lillie D. Shockney, Administrative Director of Johns Hopkins Breast Center, and breast oncologist Dr. Jennifer Litton at the Anderson Cancer Center in Houston.
How long does the surgery take, and what's the recovery time?
Thompson: The mastectomy and reconstruction surgery can last anywhere from 3-8 hours, depending on the type of reconstruction. My guess is that [Rancic] will have implant reconstruction, either delayed (with expanders) or immediate, direct-to-implant reconstruction. Patients with immediate reconstruction leave the hospital after one or two nights, and she could be back on TV in week two. It's the kind of operation where many women are back on their feet quite quickly afterward. Plus, you wake up with breasts, looking like yourself again. With clothes on, no one would know that you had breast reconstruction. And the implant is permanent.
Shockney: Those having a more complex reconstruction, such as microvascular flap reconstruction, would generally have a three night hospitalization and a four to five week recovery. It's important to emphasize that this physical recovery. There is an emotional recovery component that can take some time to get one's mind around.
Thompson: Psychologically, there's also a big relief that you're not going to be vulnerable to breast cancer. It's empowering to know that you don't have to worry about that in your life as a young mother and professional.
What sort of follow-up treatment might be necessary?
Thompson: Usually no radiation is needed unless there's extensive disease. A woman cannot have radiation treatment if she's trying to get pregnant. If a patient has a lumpectomy and radiation, she'd still have some breast tissue left. It's taking a bit of a gamble because another cancer could develop.
Litton: What a patient's treatments would be, like pills or chemo or any of that, would depend on how much invasive cancer there was and if it involved potentially the lymph nodes as well. You don't give chemo to treat what's in the breast. You give chemo to treat what kind of rogue cells may get into the bloodstream or the lymphatic stream to try to kill them before they go to other places in the body.
How will a woman's plans to have children be affected if she opts for this treatment?
Thompson: Many women go on to have children after such an operation; it does not affect childbearing. If you want to have children and you're going to need IVF, it can make sense to go the mastectomy route.
Litton: [Mastectomy patients] go through quite a bit of changes. It's body image, it's sexuality, all of those things. They're not trivial. Some people's worry is so significant that I do think [it plays] a role in some cases.
Shockney: When a young woman is diagnosed, usually she is referred to a genetics team to discuss the possibility of potentially having a breast cancer gene that is the cause of her cancer. If she tests positive for a breast cancer gene, then 50 percent of her offspring would also carry this gene. Women with such a gene have between a 40 percent and 80 percent risk of getting breast cancer and are also at higher risk of getting ovarian cancer. So some women question childbearing due to concerns about genetics.
What are the odds of a woman in childbearing years to be diagnosed with breast cancer? How much do these odds go up if the woman is undergoing fertility treatments?
Thompson: If there is no family history of breast cancer, the odds are very low for developing breast cancer under 40, but we do not really have a number for the increase in risk with fertility drugs.
Shockney: About 28 percent of women are diagnosed under the age of 50. There has not been a correlation made to fertility treatments and breast cancer developing. Personal: I was diagnosed at age 38 and then in my other breast at age 40. I had no family history and no known risk factors. Life goes on!
With additional reporting by LESLEY MESSER
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