She had her breasts, uterus and ovaries removed due to a cancer gene mutation – and found strength in family
The BRCA cancer gene mutation runs in Kiranjeet Kaur’s family. Her sister was diagnosed around the same time, and her three adult children have opted for genetic testing. She tells CNA Women about this painful family ordeal and her three-in-one surgery, which drew them closer.
Kiranjeet Kaur removed both her breasts, her uterus and ovaries after testing positive for a cancer gene mutation. (Photo: CNA/Dillon Tan)
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Learning you have cancer is tough. Finding out you carry a cancer-related gene mutation can feel even tougher.
In July 2023, Kiranjeet Kaur was diagnosed with Stage 2 breast cancer. After genetic testing, the then 53-year-old teacher found out that she carried the BRCA gene mutation, which significantly increased her lifetime risk of breast and ovarian cancer.
With guidance from her doctors, she decided to remove both her breasts – even the one without cancer – as well as her uterus and ovaries in a single procedure.
Giving up parts of one’s body long symbolising womanhood cuts deeper than the physical. But the photos Kiranjeet sent me told a different story. She looked radiant and happy.
When I met her at the National University Hospital Medical Centre, I told her that the smile in her photos touched me.
The story that she later told me was beyond what I had expected.
Around the same time, her sister was also diagnosed with breast cancer, tested positive for the BRCA gene mutation, and removed her breasts, uterus, ovaries and lymph nodes. All three of Kiranjeet’s adult children were due for genetic testing for the gene mutation as well.
HER GENE CANCER BOMBSHELL
“When I grew up, the word cancer was more of a bad word. It wasn’t spoken openly about,” Kiranjeet, now 55, reflected. “Now, I think it’s more like the flu – it seems to be a common thing.”
She said that, over the years, at least 10 of her aunts and cousins on her father’s side, and several from her mother’s side, had cancer.
In fact, a day before Kiranjeet discovered a lump in her left breast in June 2023, her sister, Sharanjeet Kaur, who was then 52, discovered a lump in her right breast. This eventually turned out to be breast cancer too.
Nonetheless, Kiranjeet admitted that she never expected this to happen to her. “I thought, why me, why now? I was close to retirement. That year was my 25th marriage anniversary. We were going to New Zealand for a self-driving holiday a month later,” she told CNA Women.
With this diagnosis, her bucket-list trip was replaced by hospital visits and chemotherapy. As she had many close relatives with breast cancer, she also underwent genetic testing to determine if her cancer was hereditary.
The chemotherapy side effects – appetite loss and weakness – were manageable. But in September 2023, her genetic test results came back. She was a carrier of the BRCA2 gene mutation.
This meant that her cumulative lifetime risk of breast cancer and ovarian cancer by the age of 80 was 69 per cent and 17 per cent respectively, according to her breast surgeon, Dr Celene Ng. Dr Ng is a senior consultant at the National University Hospital (NUH) and National University Cancer Institute, Singapore (NCIS) with a special interest in oncoplastic breast surgery.
WHEN CANCER RUNS IN THE FAMILY
A hereditary cancer gene meant that Kiranjeet’s closest family members were also at risk. She told her children, her brother and cousins to consider genetic testing. Her brother and most of her cousins decided against it, but her children went willingly.
Her eldest son Harmesh, 26, tested negative, her second son Harish, 23, tested positive, and her daughter Harsha will test after she turns 21 at the end of this year.
For Kiranjeet, testing positive also meant that even if she recovered from this cancer, there was a significant chance she could get breast cancer again, or ovarian cancer in future.
Dr Ng, who had initially recommended removing the tumour and conserving her breast now offered Kiranjeet another risk-reducing option – removing both breasts, the uterus and ovaries, all in a single procedure.
MORE ABOUT GENETIC TESTING AND RISK-REDUCING SURGERIES
What is genetic testing for breast cancer?
Genetic testing screens for mutations in genes that increase cancer risk. Two common tumour suppressor genes are BRCA1 and BRCA2. Mutations to either gene affect their DNA-repair function, potentially leading to uncontrolled cell growth, and ultimately, cancer, said breast surgeon Dr Celene Ng.
Don’t rush to get genetic testing
Most breast cancers are sporadic – only 5 to 10 per cent are due to genetic abnormalities, said Dr Celene Ng.
Doctors generally recommend genetic testing for patients diagnosed with breast cancer at a relatively young age of below 45 to 50 years old, have triple negative breast cancer below the age of 60, have multiple cancers, or have multiple first-degree relatives with breast, ovarian, prostate or pancreatic cancer, Dr Celene Ng explained.
Weigh the pros and cons carefully
Patients should see a counsellor at a genetics clinic to understand the medical and personal implications of genetic testing, including how it might affect family members, insurance coverage and employment, advised gynaecologic oncologist Dr Joseph Ng.
However, Singapore’s insurance rules stop companies from asking for – or using – predictive genetic-test results (like a positive BRCA finding) for nearly all policies. They may only consider such results if you are applying for an exceptionally large life, total permanent disability, long-term care, critical illness and disability income insurance.
Gene testing empowers patients to make better choices
There are targeted drugs that work on gene-positive breast cancers in patients diagnosed at later stages, but the main advantage of genetic testing is the ability to mitigate risk with more frequent screening. A woman can also opt for preventative surgery (removing breasts and ovaries), which reduces the risk significantly but does not eliminate it, Dr Celene Ng added.
Consider the consequences of preventative surgery
Removing ovaries in pre-menopausal women triggers sudden menopause, warned Dr Joseph Ng. This raises long-term risks of heart disease, osteoporosis and various other health conditions.
Keeping her natural breasts also carries emotional value; women eligible for lumpectomy or other breast-conserving surgeries should consider it first, said Dr Celene Ng.
If the whole breast has to be removed, it can be reconstructed immediately or later either with a silicone implant or the patient’s own tissue taken from another area of the body, said plastic surgeon Dr Yap.
It was a difficult decision, but Kiranjeet decided to proceed.
However, just before her final chemotherapy session in December 2023, she was hospitalised for COVID-19. Shortly after discharge, she developed a severe lung infection and was hospitalised again for another two weeks.
She was put on antibiotics and it took a few months to recover. She was only ready for surgery in March 2024.
A multi-disciplinary team from NUH and NCIS came together to perform the three surgeries in a single sitting. The team included breast surgeon Dr Ng; gynaecologic oncologist Dr Joseph Ng; and Dr Yap Yan Lin, who heads the Division of Plastic, Reconstructive and Aesthetic Surgery at NUH.
To reduce scarring and accelerate recovery, the minimally-invasive robot-assisted three-in-one surgery was done via a 4cm incision on each side of her chest and through five tiny keyholes in the abdominal region.
The breasts were also reconstructed via the same chest incisions. The three-in-one robot-assisted surgery was the first of its kind at NUH and NCIS, said Dr Joseph Ng.
The surgery was so successful that Kiranjeet was discharged from hospital the next day. She recovered within a week, she reported. She has since gone back to work.
A FAMILY MADE STRONGER BY TRIALS
Her body may have healed, but Kiranjeet felt the loss at a much deeper level.
“I love my breasts. I’ve never seen myself as beautiful but I always felt that my breasts were the best part of my body,” she said.
Kiranjeet felt the loss so sharply that she went to her plastic surgeon Dr Yap to ask for the faceless picture of her breasts taken before the operation. She keeps it on her phone – a cherished relic of what once was.
Kiranjeet takes comfort in the fact that she still has breasts, through the reconstructive surgery, and thanks to surgical advances, it is likely that some sensation will gradually return to them. However, she shared that currently, besides being heavier than before, she does not feel much in her breasts.
Being able to walk the cancer journey with her sister has been an unexpected silver lining, Kiranjeet added.
Sharanjeet had also tested BRCA positive, and removed her breasts, uterus, ovaries and lymph nodes, before going through chemotherapy and radiotherapy at a different hospital.
Because of their parallel experiences, the sisters were able to deeply empathise and share tips. They even joked about the size of breast implants they wanted.
“It was overwhelming. But we told ourselves we were meant to be in this journey together to make each other stronger,” Kiranjeet said.
She also drew great strength from her children.
When she got a crew cut to prepare for chemotherapy, her son Harish shaved his head in solidarity.
And when her hair started to fall out after chemotherapy, her two other children Harmesh and Harsha shaved her head and washed it. Harsha even gave her an Avatar-inspired shave that didn’t quite land but brought the family much laughter.
“These are the kids that I brought up. Yes, they are naughty and talk back at times. But they understood what I was going through and in their own way, wanted to be with me on this journey,” she said.
“I felt that connection. I felt blessed. This journey brought (my family) closer. And I think this is one bond many families will envy,” the cancer survivor reflected.
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