It didn't take long for Barb May to realize what she had to do when a genetic test showed it was almost certain she would develop breast cancer during her lifetime.
The Pasco woman's mother and grandmother are breast cancer survivors. She has seen the toll that years of battling the deadly disease can take on a woman's body and mind.
May, 41, wanted to be around to see her two teenagers grow up. She wanted to able to hike with her husband and lead an active lifestyle.
The test revealed May had around a 90 percent chance of getting breast cancer by her 70th birthday. She had a 50 percent chance of getting it within the next 10 years and a more than a 40 percent chance of getting ovarian cancer.
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To reduce the risk of cancer, May decided to have surgery to remove her breasts and ovaries.
"You just feel like it's a death sentence," May said. "I felt so powerless."
May's decision came about a year before actress Angelina Jolie brought risk-reducing surgeries into the spotlight with the announcement she had a double mastectomy.
Jolie's column in the New York Times inspired other women to get tested and take action, May said. While Jolie's announcement didn't reinforce her decision, May remembers when she heard the actress's news.
"I think I cried the day I heard she was coming out about it," she said. "I believe every woman should have the opportunity to know what choices they have."
May's journey began in spring 2012 when her doctor recommended her to Sarah Hall, a genetic counselor at Kadlec Regional Medical Center in Richland. Her family history showed cancer on both her maternal and paternal side.
Hall screened May for a test -- which can cost between $3,000 to $4,000 and was covered by her family's insurance provider -- to see if she had a gene mutation that increases a person's risk for cancer.
The red flags in May's family history qualified her for the test, Hall said. The multiple generations of women on May's maternal side with breast cancer and the age at which they got it at worried Hall.
"We looked at the family history, and I was definitely concerned there was inherent risk for breast cancer on her mother's side," Hall said.
May's grandmother fought breast cancer twice, and her mother spent two years fighting the disease with chemotherapy.
May's fears were confirmed when the test came back positive for the BRCA2 gene, a mutation that increases the risk of breast and ovarian cancer.
May had a few choices following the positive test result, she said. She could take a chemotherapy pill for five years, get more thorough screenings on a regular basis or undergo the surgeries.
May went to Seattle Cancer Care Alliance, and doctors there examined her and provided more information about the different options she had.
"The Seattle trip was a confirmation," she said. "Nothing against the doctors here, but we needed that confirmation. The doctors were saying the same thing."
Visiting doctors in Seattle only shored up the decision May had been leaning toward since her results came back positive, she said. Though a lot of people, including her husband and friends, were skeptical, May decided she wanted to go through with the surgeries to remove her breasts and ovaries.
A few weeks after her trip to Seattle, a gynecologist from the Cancer Care Alliance called and said there were concerns with an ultrasound May had while in Seattle. The doctor recommended that if May was going to go through with getting her ovaries removed, she should come in as soon as possible to have a hysterectomy as well.
Within weeks, May, who works for Washington River Protection Solutions, was in Seattle to have the hysterectomy, she said.
"It happened pretty quickly," she said. "I had to trust they knew what was best."
The surgery -- which took away the possibility of May having any more children -- also forced her body into medical menopause, she said. It took her six weeks to recover.
Then she went back to Seattle for the double mastectomy. The surgery took more than four hours and dramatically changed the way her body looked.
"They took everything under the collarbone and scraped it off," she said.
A plastic surgeon performed a reconstruction surgery the same day of the mastectomy, May said. When May woke up, she was shocked at how different her body looked.
Though May had mentally prepared herself, the crumpled skin around her chest left her questioning if she had made the right choice, she said.
She spent the next six weeks recovering. The following months were spent reconstructing her chest, May said. Her husband added saline into her skin to help stretch the skin to prepare for more reconstructive surgery.
As the recovery moved along, May began to feel more confident about her body and her decision, she said. In April, she got breast implants and soon will be done with her reconstructive surgery.
"It was more about getting to the point of being able to accept who you are as a person," she said.
As May recovered, she looked for online support groups to help her cope with her new body, she said. She stumbled upon a woman's Facebook page who had the same surgeries. The woman posted pictures of herself in a bikini contest, and May was inspired.
May began working out soon after the double mastectomy to give her the confidence to pursue the active lifestyle she wanted. She began training at the gym six days a week, eating healthier and running. Within months, May dropped her body fat from about 21 percent to 12 percent and was on her way to getting the body she always had desired.
Now, May is a self-described health nut who proudly shows off before and after pictures of herself. She recently entered a body-building contest -- where she had to wear a bikini -- and won "most inspirational."
"I can put on a mean sports bra or Victoria's Secret bra and look better than I did when I was 22," she said.
May's husband of five years, Randy May, has watched his wife go through the remarkable transformation during past the past year and a half. The whole family has followed her lead and taken a healthier approach to life.
"She is physically healthier today than she has ever been," he said. "She looks better today than she did before the surgery, better emotionally and spiritually."
May's decision to get tested and go through with the risk-reducing surgeries has prepared her 15-year-old daughter for the reality that she, too, could have the BRCA2 gene.
Ashley May was scared for her mom at first, though the whole process has left her with a better understanding of her family history and what it could mean for her, she said. Ashley, a sophomore at Delta High School in Richland, plans to get the genetic test once she turns 21.
If Ashley does have the gene mutation, the first thing she will do is talk to her mother to decide on the best decision, she said. Rather than living her teenage years in fear of one day having a mastectomy, Ashley wants to learn as much as she can about the BRCA2 gene.
"It's scary," she said. "But I am curious about it. I want to know how it works and how it gets passed down. If I have it, I want to find a way I can prevent my children from getting it."
Sitting recently in a Starbucks in Richland, Barb May talked about how she wants women to hear her story to hopefully be inspired to take control of their lives. She wore in workout clothes and running shoes as she talked about the rollercoaster of emotions the surgery has caused.
"When you feel good about yourself, you feel empowered. You feel invincible," she said. "And, honestly, it's awesome."
-- Tyler Richardson: 582-1556; firstname.lastname@example.org; Twitter: @Ty_richardson