COMING OUT FIGHTING WOMAN WITH CANCER GENE TAKES DRASTIC PREVENTION.

Byline: PATRICIA FARRELL AIDEM Staff Writer

SHERMAN OAKS - Wendy Kretchmer never met her grandmother, but linked by genetics to her death, she took a drastic step to ensure her own grandchildren don't suffer the same hole in their family tapestry.

Thirty-six and healthy, Kretchmer had her breasts surgically removed last week in a grueling 7 1/2-hour procedure after a genetics test showed she faced a more than 80 percent chance of someday developing breast or ovarian cancer.

``Some people look at it as me mutilating my body,'' Kretchmer said on the eve of Tuesday's surgery at Cedars-Sinai Medical Center. ``Some people say that, given my odds, they'd do exactly the same thing.''

Kretchmer, who lives in Sherman Oaks, got used to jaws dropping when she disclosed her decision to undergo a prophylactic bilateral mastectomy and subsequent breast reconstruction.

But it took little to convince her skeptics that it was the right thing to do.

John Kretchmer backed his wife from the start.

``I'm absolutely fine with it,'' he said as his wife recovered. ``What's the alternative?

``We all have heard about what going through chemo is like. This isn't fun, but it sure is better than finding out you have cancer, facing the possibility of death.

``She's doing it for herself and she's doing it for me and our children. She's remarkable.''

It's a decision that most experts support.

``For a woman who tests positive at 36, I would do exactly what this woman did,'' said Dr. Susan Love, author of the groundbreaking ``Dr. Susan Love's Breast Book'' and president of a research foundation dedicated to curing the disease.

``This is a pretty drastic way to deal with the problem,'' Love said.

``It reminds me of when I started practice. PAPs (to detect cervical cancer) had just come out. If they were abnormal, we did a hysterectomy. Now we have local treatment, but in those days you removed the organ.''

Kretchmer's genetic mutation -- the BRCA gene -- increases the chances of breast and ovarian cancer, the latter which killed her maternal grandmother. Her mother's sister is a breast cancer survivor.

Kretchmer underwent a hysterectomy in December, reducing -- but not eliminating -- her chance of developing breast cancer.

She never knew her mom's mother, who died in her 50s, and didn't want her own two daughters, now 6 and 2 1/2, to lose their mommy. Nor did she want to risk the numbing news of a bad mammogram and face radiation, chemotherapy, surgery and possible recurrences.

``They gave their children the most precious gift, that is they took away this sword of Damocles hanging over their mother's head,'' said Trudy Harris, co-executive director of the Lynne Cohen Foundation for Ovarian Cancer Research, where Kretchmer underwent genetic testing and counseling.

``Once she recovers, it's going to be gone from the table, her risk is gone. Her children aren't going to grow up with this sword hanging over their heads: Is Mommy going to get breast cancer? What are the results going to be from her tests this time?

``That's really a beautiful gift to give her children.''

But Harris also is quick to point out that women who carry the BRCA gene have options. Mammograms and MRI tests performed regularly should spot cancer before it progresses.

Some 274,900 women in the United States will be diagnosed this year with breast cancer and about 40,970 women will die, according to the National Breast Cancer Coalition. It is the leading cause of death among U.S women, 20 to 59, and the leading cause of cancer death for women worldwide.

For Kretchmer, the decision to undergo surgery was relatively easy to make, and she said in an interview before the surgery that people who learn her reasons support her. She will spend about $30,000 out-of-pocket for her surgeries, which are not covered by health insurance, and a share of hospital and other expenses.

Last summer, Kretchmer's best friend was diagnosed with advanced ovarian cancer.

``It was shocking,'' Kretchmer said. ``I thought, I'm the one with the family history, and that pushed me to do the testing.''

While the friend battled through treatment -- ``It's been a really rough ride'' -- Kretchmer learned she carried the BRCA gene.

``For me, the hardest part of this whole thing is losing my breasts,'' she said. ``They're small, but they're still perky after having kids. I think about waking up and them being gone and I get really emotional.''

At first, husband John was skeptical and more recently had admitted to her he expected to have trouble looking at the results of the surgery.

``He said last night, `I'm so glad you're doing this. I don't think the girls and I could live without you,''' Kretchmer said a day before surgery. ``We both know these aren't great circumstances but this is the right thing.''

Kretchmer will undergo a complex reconstruction process that will include implants and end with tattooed nipples to replace the real thing -- minus sensation.

``At worst, people will say, `Oh, she got her boobs done,''' she said before surgery. ``I'm going to roughly look the same... maybe a little less like I've had two kids.

``I'm not trying to go for vavoom.''

Women who have undergone preventive mastectomies have formed their own small society across the nation. They communicate in computer chat rooms and in this area, get together to socialize, support one another and share stories -- and just-for-us-girls reconstruction successes.

``When we get together, at one point all the women go into the bathroom for `peek-a-boos,''' Kretchmer said. ``They've had all different kinds of reconstruction jobs.''

The two forms of the BRCA gene -- the more common one affects just women -- were discovered in 1990. The gene is a mutation of the body's natural ability to suppress tumors and is linked to genetic breast and ovarian cancers.

Families that carry the gene tend to have a high incidence of breast cancer, often at a young age, according to SusanLoveMD.org, the Web site run by the renowned breast cancer specialist.

Five to 10 percent of women with breast cancer have the gene, Love said, noting that translates into low numbers compared with data showing that one in eight women with or without the gene will get breast cancer.

Kelli, a 45-year-old woman who asked that her last name not be used, is a breast cancer survivor with no family history of the disease.

A tumor proved malignant eight years ago and Kelli had a lumpectomy, underwent radiation and chemotherapy, then two years later elected to have a full mastectomy because the cancer threatened to re-emerge.

Knowing the difficulty of the surgery, Kelli said she couldn't imagine choosing to double that if there were no cancer. With that knowledge plus a touch of vanity, Kelli said she probably wouldn't consider prophylactic surgery.

``I probably would have gone on faith that hopefully I won't get it,'' she said. ``After having the right side mastectomy -- that's major, major surgery -- I can't even fathom having both sides done.''

Yet after mulling the concept overnight, Kelli said she probably would encourage her young adult daughter to go through the surgery if genetic testing showed she faced the nightmare her mother endured.

``I wouldn't want her to go through any of that -- the fear, the worry, the possibility you might die. This forced me to think that through.''

Dr. Love is certain Kretchmer's and Kelli's daughters won't face their mothers' terrors. She's confident a cure will come in 10 years, perhaps five.

``By the time they grow up we'll have this figured out. There's no question,'' Love said. ``We're working on this so that those little girls won't have to face this.''

The Lynne Cohen Foundation is testing a drug that reduces the density of breast tissue in post-menopausal women to improve mammogram images. Love talks of the possibility of squirting a small amount of chemotherapy into the milk ducts, where cancer begins, to kill it on the spot.

``What's really important is that there are more choices now that we can detect when there's a risk,'' said Harris of the Cohen Foundation, which is affiliated with the University of Southern California.

Women who carry the gene face a 30 percent to 80 percent lifetime risk of getting breast cancer, based on the various mutations of the gene, family history and possible environmental factors.

Kretchmer didn't like the odds.

``I was born this way,'' she said. ``I've had the genetic mutation my whole life. These are the cards I was dealt. The way I see it I can choose to look at those cards and choose to win the game. People who choose not to look at the cards don't have a better chance of living.''

pat.aidem(at)dailynews.com

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CAPTION(S):

2 photos

Photo:

(1 -- color) Wendy Kretchmer, 36, pictured with her mother, Suzane Brokaw, had both breasts removed after a genetics test showed she faced a steep risk of developing breast or ovarian cancer.

(2 -- color) Wendy Kretchmer decided to head off a potential bout with breast cancer by undergoing a double mastectomy, putting husband John and daughters Alexa, left, and Drew at the forefront of her decision. ``She's doing it for herself and she's doing it for me and our children,'' said John Kretchmer. ``She's remarkable.''

Evan Yee/Staff Photographer