Lipstick, tattoos and the truth about mastectomy

“Why I Wore Lipstick to My Mastectomy,” a Lifetime docudrama, Oct. 23.

The premise: Geralyn Lucas is just beginning a job when she’s diagnosed with breast cancer at the age of 27. The non-invasive cancer has an extensive intraductal component involving three separate areas of her breast. After debating whether to have a lumpectomy or a mastectomy, she chooses the latter, with adjuvant chemotherapy. Despite frequent episodes of nausea and vomiting, Lucas (played by Sarah Chalke) continues to work, buoyed by her friends. She also bolsters her mood and self-image by dressing well, getting a tattoo -- and wearing lipstick. Although at first worried that her husband will leave her, especially when she spies him speaking privately with a nurse, he ultimately proves to be very supportive. Lucas goes on to become pregnant and deliver a healthy child.

The medical questions: What is the standard of care for early breast cancer in a pre-menopausal woman? What role do genetics play? How likely is she to conceive a child after chemotherapy? Would it have been prudent to freeze her eggs before undergoing treatment? How common is depression?

The reality: In women younger than 35, lumpectomy plus radiation has been shown to have a greater rate of local recurrence than mastectomy, but similar rates of long-term survival. “Certainly where a cancer is found to involve three separate areas of the breast, mastectomy is a prudent and appropriate option,” says Dr. Daniel F. Roses, a professor of surgery and oncology at the NYU School of Medicine and author of “Breast Cancer.”

Genetic testing is prudent, because at least 20% of women with early-onset breast cancer have been shown to have the BRCA1 or BRCA 2 mutation. Knowledge of these mutations (which Lucas doesn’t have) can lead to more aggressive treatment and possible preemptive removal of the ovaries because of the associated risk of ovarian cancer.

Chemotherapy improves survival rates in patients with a significant risk of recurrence, but the treatment often affects ovarian function and potential fertility. Standard chemotherapy induces amenorrhea (a cessation of menstruation) in almost 80% of women older than 40, but less than 20% of cases younger than 30. In vitro fertilization in combination with anti-estrogen drugs can theoretically help maximize fertility while diminishing the effect of estrogen on potentially recurrent cancer.

The full effects of chemotherapy on fertility, as well as the effects of pregnancy on breast cancer recurrence, are not known. Before receiving treatment, some women opt to “freeze their eggs,” known as cryopreservation, but this is not as crucial in younger women, for whom loss of fertility is not nearly as common.

Finally, a 2005 study in the British Medical Journal showed that more than half of women suffer varying degrees of depression or anxiety, especially in the first year of diagnosis of early breast cancer. As for Lucas’ fears about her marriage, a few studies completed since 1988 show no increased tendency for husbands to leave wives who have breast cancer, unless the marriage was on the rocks beforehand.

Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He can be reached at marc@doctor siegel.com.