Last December, Tara Treppiedi felt exhausted. No matter how much extra sleep she got, she never seemed to bounce back. “I work full-time, I have two young children,” she says. “I figured everything was taking its toll.”
Treppiedi had lost her mother to cancer two years earlier. Her mother’s grandmother had died of breast cancer. Her mother’s mother had survived an early bout with breast cancer and is still alive 26 years later. Treppiedi, 41, a retail planner at Burlington Coat Factory in Burlington, was aware of the genetic implications of her maternal lineage. She had begun getting an annual mammogram at 35, five years earlier than the usual recommended age.
Treppiedi was less diligent about performing monthly breast self-exams. “I could never remember what time of month I was supposed to check,” she admits, “and it was hard to tell what exactly I was feeling.” Many premenopausal women have the same difficulty—it is not uncommon for breast cells and connective tissue to be more concentrated in some parts of the breast than in others, and within the surrounding fat these small clusters can feel thick or lumpy. In addition, tiny calcium deposits may form within the breast, though almost 85 percent of them turn out to be benign.
Not unduly worried, Treppiedi had her usual annual mammogram in June. “When they came back in a third time to take more pictures, I thought, Uh-oh, this isn’t good,” she recalls.
And it wasn’t. The mammogram had revealed a cluster of tiny calcium deposits, or calcifications, in her right breast. An ultrasound showed them to be two small lumps, possibly cancerous. A biopsy followed. Several days later, Treppiedi got a call from her doctor’s office asking her to come in that very morning.
“I knew I was at high risk, but I didn’t think it would happen so soon,” she says. “As I sat in the examining room and was told it was cancer, I knew immediately I would have both breasts removed.”Dr. Michele Fantazzio, Treppiedi’s breast surgeon at Virtua Hospital in Voorhees, concurred that a mastectomy of the right breast was imperative. But Fantazzio cautioned her patient that it was not absolutely necessary to remove the left breast, and asked her to think it over.
Since her mother’s death, Treppiedi says, “I’d thought about it a lot, and there was no question a double mastectomy was the right choice for me. I didn’t want to go through this again. I needed that peace of mind.”
When a subsequent MRI showed pockets of abnormal—though not cancerous—tissue in her left breast, Treppiedi felt vindicated. Preventive mastectomy reduces the likelihood of cancer recurring in the excised breast by approximately 90 percent—though the small amount of breast tissue that remains is still at risk. Research also shows that, after the onset of cancer in one breast, the risk of it occurring in the other breast increases about 1 percent per year. In late August, twenty days after receiving the biopsy results, Treppiedi underwent surgery to remove both breasts.
Immediately following the mastectomy, as part of the same procedure, balloon-like devices called tissue expanders were inserted under Treppiedi’s pectoralis muscles. Each contains a port through which the surgeon, over time, adds increasing amounts of liquid, ultimately creating a pocket for an implant.
“Expanders allow for a uniform appearance and less postoperative discomfort,” says Dr. Steven Shoen, a plastic surgeon specializing in reconstructive breast surgery at Robert Wood Johnson University Hospital.
Treppiedi has two daughters. “At first, my three-year-old was most concerned how it would affect her daily schedule,” she says. “But my five-year-old knew it was more serious. We talked about it, and I emphasized that I was doing everything I had to do to get well, although some of the medicine will make me look different. By the end, she understood.”
As a wife and mother, Treppiedi decided to have the blood test to determine whether she carries the BRCA1 or BRCA2 breast cancer gene. “I needed to know for my daughters,” she says. In October, she tested negative for the gene. (BRCA1 and BRCA2 genes are suspected to be present in only 2 percent of the U.S. population. Yet about 80 to 85 percent of women with either gene will develop cancer.)
For strength, Treppiedi thinks of the 26 years her grandmother has survived after breast cancer. Women diagnosed in the earliest stages of breast cancer—with 0 being the earliest and IV the most advanced—have a relative five-year survival rate of 89 percent, according to 2007 data from the American Cancer Society. (Relative survival rates don’t include patients who die from other causes.) Five-year survival rates decrease with each progressive stage.
“I appreciate the little things so much more,” says Treppiedi, who was diagnosed at Stage IIB. “I want to soak it all in and spend time with [my husband and children]. There’s always something to be done around the house, but now I postpone some cleaning so I can be with them, one on one. And I find I cut people more slack. Who knows what they might be going through?”