Trading Healthy Organs for Reduced Cancer Risk

February was National Cancer Prevention Month, and the media was full of reminders about healthy lifestyle choices that can help you lower your risks for the disease. But at the end of February, Brian Chelcun, age 26, took his cancer prevention one step further, and had his at-risk stomach removed. Such a procedure is called prophylactic surgery, and simply means the removal of a healthy organ or gland that is at risk for developing cancer. It is the chosen route of many people considered high-risk for the disease. High risk can include family history, personal history, or genetics. Now that scientists can perform genetic testing that makes determining actual risk much simpler, prophylactic surgery is an easier choice for some.

Knowing that your stomach's chance of housing cancerous cells is great despite preventive measures, you might be less hesitant to have it taken out in a prophylactic surgery called a gastrectomy. "To have prophylactic surgery when you didn't know what your risk was was pretty drastic. Now you can know definitively," explained Dr. Sapna Syngal, director of the Familial Gastrointestinal Cancer Program at the Dana-Farber Cancer Institute in Boston, MA and associate professor of medicine at Harvard Medical School.

That was exactly the case for Chelcun. On February 8, his father died after battling gastric cancer. Chelcun knew that many of his paternal relatives also had the gene mutation that increases the chances of stomach cancer, and after a biopsy revealed potentially cancerous cells, he made his decision. "After they found that, there was no real reason to wait," he said. An aunt and uncle on his father's side had both already undergone successful gastrectomies. The rest of the family was supportive of Chelcun's choice, especially since gastric cancer is challenging to screen for and diagnose. While it sounds life-altering, a gastrectomy does not necessarily mean an end to eating or even appetite. Although some people experience unpleasant reactions to the removal of all or part of their stomach, many continue to eat and digest without problem. Still, the decision to have any healthy organ removed hinges not only on physical need, but emotional preparedness. "Any decision they make has to make medical sense as well as emotional sense," said Karen Hurley, assistant attending psychologist at Memorial Sloan-Kettering Cancer Center in New York. "Even with a strong recommendation to have surgery, you still have to find a way to make it your own, and not just because somebody else told you to because, in the event of complications, that leaves you open to the possibility of regret." That said, there are situations in which the experts agree that regular screenings are preferable to prophylactic surgery.

For example, anyone over 50 - as well as people at high risk for colon cancer - should get a colonoscopy every year (March is Colon Cancer Awareness Month). Colon cancer is one of the more detectable and curable forms of the disease. Colonoscopies can also be considered a preventive measure because the procedure allows physicians to remove suspicious polyps in addition to simply looking for problems. The pap smear is another highly effective cancer prevention screening that women should have done annually. Brian Chelcun is in a small group of people for whom "waiting it out" was not an option. Fortunately, he was able to act before cancer even appeared, and will hopefully never have any further need of surgery.

However, it is essential that anyone leaning toward prophylactic surgery consider the physical, emotional, and spiritual aspects of the decision. For example, even if the organ is removed, what are the chances that the cancer will appear somewhere else? How far is too far when it comes to not only life quantity, but life quality? The best advice is to seek the help of spiritual and emotional guides as well as that of the medical professionals.

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