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About 12 percent of women in the general population will develop breast cancer sometime during their lives. But about 45 to 65 percent of women who inherit mutations to one of the BRCA genes will develop breast cancer by the age of 70, according to the National Cancer Institute.
BRCA gene mutations are responsible for about 5 to 10 percent of all breast cancers and about 15 percent of ovarian cancers, according to the cancer institute.
The mutations also increase the risk of breast cancer for men and may also increase the risk of other types of cancer in women and men, such as pancreatic cancer, according to the cancer institute.
Brandy McEllrath hadn't been given a breast cancer diagnosis when she made the decision to undergo a double mastectomy. But by the time she went under the knife on April 19, 2012, that had changed.
An MRI before the surgery revealed a small mass. A biopsy proved it was cancerous. During the procedure, surgeons discovered a much larger mass growing against her chest plate. A tissue sample later revealed it, too, was cancerous.
"That one might have been the killer," McEllrath said.
McEllrath, of Vancouver, made the decision to undergo preventive surgery after learning she had an inherited gene mutation that put her at significant risk of breast and ovarian cancers. Earlier this year, actress Angelina Jolie made a similar decision after also testing positive for a gene mutation.
While the mutations are rare in the general population, they are inherited. A child of a person carrying the mutation has a 50 percent chance of inheriting it, according to the National Cancer Institute.
That means McEllrath's two daughters — Sydney Stockwell, 19, and Gillian Stockwell, 14 — may soon face similar decisions.
The news rocked McEllrath's family. But the 41-year-old is thankful she learned of the mutation before it was too late.
"I think it quite literally saved my life," McEllrath said.
In January 2012, McEllrath had an appointment with a new gynecologist. The physician asked about McEllrath's family history. She gave details about her mother's side of the family. She never knew the medical history on her father's side of the family was relevant.
When the gynecologist asked about her father's family medical history, McEllrath realized just how prevalent cancer was on that side of her family.
Her aunt had recently died from liver cancer but had also fought breast cancer. Her grandmother also had breast cancer and died from another type of cancer. Her great-grandmother had cancer, too.
Her gynecologist told McEllrath she might consider a genetic test to determine whether she inherited a mutation to her BRCA1 or BRCA2 genes, which are breast cancer susceptibility genes. After learning more about the increased risk women with gene mutations face and receiving counseling from a local oncologist, McEllrath decided to undergo testing.
About six weeks later, McEllrath learned she tested positive for a BRCA2 gene mutation. Doctors told McEllrath she had a 94 percent chance of getting breast cancer.
"At first, I was shocked," she said. "Wow, this 30-second conversation changed my life. I have a 6 percent chance of not getting cancer."
"Mortality is a factor of my life now, and I have to face that," McEllrath said.
The positive result posed a new question for McEllrath: What, if anything, did she want to do about it?
She elected, despite protests from some family members, to have a double mastectomy.
"I felt like it was my responsibility," she said. "If what happened in the past wasn't working in my family, I could be the one to change that."
The initial mammogram before the surgery didn't reveal any abnormalities. An MRI showed a little spot that looked unusual. A biopsy revealed cancer.
Up until that point, the mastectomy had been elective. Now, she said, it was necessary.
During the mastectomy, surgeons discovered the larger mass. Tests of her lymph nodes came back clear; the cancer hadn't spread.
After the mastectomy, McEllrath underwent several additional surgeries to reconstruct her breasts, replacing her own tissue with implants. She completed the reconstruction process this past June.
Because the BRCA mutation also put her at increased risk of ovarian cancer, McEllrath decided to undergo a hysterectomy as well. During the procedure, on Oct. 31, 2012, surgeons discovered a mass on one of McEllrath's ovaries, but it was not cancerous.
After learning she inherited the mutated BRCA gene, McEllrath felt it was her duty to educate the other women in her family. Both of her sisters were tested. One's test came back positive, and she underwent a double mastectomy. The other sister's test came back negative.
McEllrath's eldest daughter, 19-year-old Sydney, was tested in April. She tested positive for the mutation.
"I was shocked," Sydney said. "It took a while to set in."
After a few days, she came to terms with the news. Doctors don't recommend any preventive action until Sydney's at least 25 years old. She carries the knowledge that she, too, is susceptible to breast cancer, but she keeps it tucked away in the back of her mind so it doesn't consume her.
"You just kind of accept it and go on," she said.
McEllrath's younger daughter, 14-year-old Gillian, must wait several more years before she can be tested. But, once she's mature enough to handle the results, Gillian wants to take the test.
"It's not a club I'd like to join," she said, "but it's something you'd like to know."
Dr. Allen Gabriel — a Vancouver plastic surgeon who specializes in breast reconstruction and created a nonprofit, Pink Lemonade Project, to advocate for women's reconstruction rights — said he's seen many Clark County women undergo double mastectomies and reconstruction surgeries after testing positive for BRCA mutations.
McEllrath, however, is the first patient Gabriel has treated who also had a sister and daughter test positive for the mutation.
McEllrath is teaming up with the Pink Lemonade Project to serve as a resource for other local women who are considering the test or who have received a positive test result.
When McEllrath was grappling with the news that she carried the gene mutation, she desperately wanted to grab a cup of coffee with someone who had gone through what she was facing. She struggled to find that someone.
"That's what I want to be for others," she said. "To let them know they have resources and they have advocates."