On Aug. 13, Anna Hall had her biggest fear removed.
The Murray, Utah, woman elected, at age 29, to have a double mastectomy to all but eliminate any risk that the breast cancer that claimed her mom and other relatives would shorten her life.
Because through gene testing she discovered she had a BRCA1 gene mutation, Anna Hall knew her own lifetime risk before having the surgery was between 67% and 87%. It’s now not quite zero, but is certainly greatly reduced, which is a huge relief for a woman who has seen breast cancer blaze through both sides of her family, affecting young female relatives on her mom’s side and an older male relative on her dad’s.
Her mom, Michelle Hall, was diagnosed with stage 2 breast cancer when Anna was 5. Her mom was 33 at the time, and after undergoing radiation and chemotherapy, she was in remission for a year, then the cancer came back and she was told it was not survivable. When Anna was 9, her mother died. Michelle Hall was 37 years old and her husband Jim raised their two young daughters, later with the help of their stepmother after he remarried.
Her grandfather on her dad’s side also succumbed to breast cancer, though he was older and breast cancer is less common in men than in women. Anna Hall can name other relatives who’ve been diagnosed with breast cancer and others who have died.
It’s been a looming shadow, she said. “I always grew up with a fear of it.”
Among her childhood memories are watching her vibrant mom become terribly ill and weak, unable to do things with the husband and daughters she adored. Hall said she has always known she would reduce her own risk surgically if she’d inherited the danger. Once she learned she had, the question was when.
She was far less afraid of the surgery and recovery than she was of putting it off. But while she has been proactive in facing the risk, she’s also been busy launching a career.
A lifetime of vigilance
The National Cancer Institute reports that “the risks of developing breast and ovarian cancer are markedly increased in people who inherit a harmful change in BRCA1 or BRCA2,” two genes with mutations closely tied to breast cancer risk. BRCA literally stands for “BReast CAncer gene.” Those with a mutation have increased risk of some other cancers, too, but that risk is less than for breast and ovarian cancer.
Those with a “harmful change” in either BRCA gene “also tend to develop cancer at younger ages than people who do not have such a variant,” per the institute. The fact a person usually has only one copy of the gene with the variant is a good thing, but its protective benefits can be lost over the course of a lifetime, so risk of cancer is “markedly greater” than among those without any BRCA variant.
The institute reports that more than 60% of women who inherit a harmful variant in BRCA1 or BRCA2 will develop breast cancer at some point. The risk for women in the general population is about 13%. And for those who develop breast cancer in one breast, the risk is significant for later breast cancer in the other breast.
The risk of breast cancer from a BRCA mutation is much less for men, at between 0.2% and 7.1% by age 70, but it happens. And it happened in the Hall family.
So Hall got tested when she was 22 to see if she had inherited a BRCA mutation. She was attending Utah State University at the time and had the blood test done. She learned that she had inherited a BRCA 1 mutation. Because of her family history and her status as BRCA positive, as well as her breast tissue density, she and a specialist developed a vigilant monitoring plan. Dense breast tissue can make it hard to spot breast cancer and may also increase its risk. The doctor recommended a breast MRI every year and ultrasounds as needed “until I decided what I wanted to do,” she said.
“I always knew, once I found out I had a mutation, that at some point I would want a prophylactic double mastectomy,” Hall said. “No one who had breast cancer in my family survived. So I was waiting for the right time.”
Doctors told her that before age 30 would be best, since her mom was diagnosed so young. If she decided to have a preventive surgery, that would be the best time to do it.
Not a tough decision
While she worried some, she was also busy living, so timing mattered.
Hall was attending law school at the University of Utah, and put off surgery to make sure she was well covered by health insurance. She graduated last year and got a job as an attorney. This year, she felt like it would all work out, so she had the double mastectomy and began the reconstruction process. She’ll have a second surgery at the beginning of next year to get implants.
She had almost a month off from work to recover and said she is doing well.
She’s very open about the surgery because she knows that some women may be hesitant if faced with the same choice. She benefited from others telling her their story and hopes her story will be helpful, too. She said that she’s thrilled to let go of the cancer fear and she knows that’s what her mother would have wanted for her. She also thinks she’s not the only one in her extended family that has made this choice.
“I know that some women struggle with the fact that breast tissue is no longer there,” Hall said. “I haven’t felt that struggle. My family never focused on our bodies or how we looked at all. It was about being healthy. I think that helped me in this situation. All my friends and family are incredibly supportive. Everybody really, even at work. Take the time you need.”
And she certainly doesn’t miss the constant worry. “A couple of years ago, I found a lump. The biopsy came back that it was benign. When I found the lump, before I got the biopsy, I broke down. I was crying, upset. How do I finish law school? What do I do?”
Hall decided then that she would reduce her risk the first chance she got. And she did, after doing research to find the right surgeon and plastic surgeon.
Online support was huge, as well. She found a group on Instagram called “The Breasties,” made up of others who were somehow connected to breast cancer and she asked them questions. She found other resources where she could ask questions and talk about her fears, including those of getting the surgery. One question: “Am I going to regret this?”
The response was immediate and overwhelming: Women years out from a double mastectomy told her they’d never regretted their choice. She found an old classmate who’d faced the same choice and made the same decision. And she did a lot of online research and outreach.
“One of the beautiful things about social media,” Hall said, is finding Instagram posts and videos from people she could message and ask questions. It also becomes a way to help others and be helped, not just with information and personal experience, but with tangible stuff. She had to wear surgical drains for a while after surgery and a woman shipped her a hoodie that was made for the purpose of hiding the drains. “It’s a beautiful community,” she said, with people sharing their stories to help others. She said she hopes to help others as she was helped.
A busy, full life
Hall is back to work and nearly back to normal.
For her, that means time with family and friends. “I am very much a quality time person,” she said, noting she loves going to movies, shopping, taking a sisters’ trip to Disneyland. “I do think some of that comes from losing my mom and other family members at such a young age. I savor every moment I have with people.”
When she’s not with others, she devours books and belongs to two book clubs. She laughs when people ask her favorite genre, because she’ll read almost anything. She credits her broad taste in and deep love of books to her dad’s mom, who was a librarian and gave her books every holiday.
If friends of family say they’re going hiking, she’s always game to go with them.
She loves people. And her life.
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