In 1997, my stepmother Faith Fancher, a longtime television reporter with KTVU Channel 2, was diagnosed with breast cancer. At 46, she underwent a mastectomy and breast reconstruction.
Afterward, she said she felt like she had a bomb ticking in her breast that could go off at any time. Two years later, the cancer came back. After a valiant battle, she died in 2003 -- during breast cancer awareness month in October.
After her mastectomy, Faith used to always say, "I am more than my left breast."
I thought about that when actress Angelina Jolie disclosed in a New York Times Op-Ed that she had chosen to have a double mastectomy as a preventive strike against this killer that cuts short more than 40,000 women's lives every year.
Jolie does not have cancer. However, she carries a particular gene called BRCA1 that -- according to a genetic test -- gave her an 87 percent chance of contracting breast cancer and a 50 percent chance of getting ovarian cancer. Jolie lost her mother to ovarian cancer. She said that she had recently undergone a double mastectomy and breast reconstruction surgery in the hopes of preventing her own children from suffering a similar loss. It reduced her odds of contracting breast cancer from 87 percent to 5 percent.
I can't imagine what it must be like for a perfectly healthy woman -- regardless of who she is -- to feel that her best choice for survival is to cut off her breasts. It took courage for Jolie to make such a frightening choice and to publicize it. She wanted to encourage other women with the same extremely elevated risk of contracting breast cancer -- due to family history -- to consider all of their options. Including the most drastic choice.
Yet the fact is, many women of more modest means don't have easy access to genetic counseling to learn whether they are at risk of hereditary breast cancer nor can they afford the $3,000 gene test. Nor the out-of-pocket fees that can run into the thousands of dollars for insurance covered mastectomies and breast cancer reconstruction.
"It's a case of the haves versus the have-nots," said Dolores Moorehead, client services manager at the Women's Cancer Resource Center in Oakland. Moorehead who works with underserved clients said she doesn't know of a single woman who'd had genetic counseling to determine whether she was a candidate for preventive mastectomy.
Medi-Cal fairly recently started covering genetic counseling and testing but it is not widely available at public hospitals.
"The fact of the matter is, there are a lot of women out there walking around in the world with these ticking time bombs," says Rena Pasick, a professor at UCSF who directs community education and outreach for the UCSF Helen Diller Family Comprehensive Cancer Center. "But as always, women with limited education and income are the last to be able to avail themselves of scientific advances."
Pasick has been working with community organizations -- including the Women's Cancer Resource Center -- churches and Bay Area hospitals to expand genetic counseling and testing to low-income women and those who live in more remote areas to help them determine whether they are at risk for hereditary breast cancer.
UCSF -- with help from a grant from Susan G. Komen for the Cure -- has been training health ministries at 10 African-American churches in Alameda, Contra Costa and San Francisco Counties to help them teach women in their communities how to assess their family histories and connect them with genetic testing services.
Pasick is concerned that Jolie's announcement could have an unintended negative effect of leading women to believe that a mastectomy is their only option for treating hereditary breast cancer. That some who are afraid or unwilling to have a mastectomy might avoid consideration of their family history or seeing a genetic counselor. In an effort to spread the word, the Women's Cancer Resource Center is planning to hold a community meeting July 31 on hereditary breast cancer and genetic testing.
Regardless of a woman's financial circumstances, she should be able to take advantage of this potentially lifesaving medical advance.