At the age of only 19 - when most young women are worrying about which university to attend or which career path to follow - Eleanor Howie faced an altogether more serious dilemma.
Her mother Elizabeth and her aunt Lesley had been diagnosed with breast cancer at the age of only 30 and Lesley died just four years later.
Now, thanks to developments in genetic testing, Howie could find out if she has a BRCA1 gene mutation that was thought to be the cause of the deadly cancer in her family.
"We had long suspected that there was some genetic component but testing wasn’t available when my mum and her sister had cancer," says Howie, now 34, who lives in Norfolk with husband Jonathan, 49, a doctor.
"When it did become available, we discovered (via a stored sample of my aunt’s blood) that both mum and her sister carried it. It was a daunting prospect but I knew I wanted to find out if I carried it too.
"When I found out I did, it felt like a tonne of bricks falling on my head. I spent the weekend crying because suddenly this was all ‘real’. I’d have some very big decisions to make in the future."
In fact, empowered by the knowledge, Howie made one of the most drastic decisions a woman can make – she chose to have her healthy breasts removed in a double mastectomy to prevent the disease from ever taking over her body.
"I didn’t have a great deal of options," she admits. "Mammograms are not particularly helpful for young women because the breast tissue is so dense and although women in my position can now have annual MRI scans, I didn’t want to be living my life worrying about breast cancer from scan to scan.
Read more: How and when to check your breasts
"The advice I’d been given was that if I were to have surgery, I should have it five years before the earliest diagnosis of my family member - so that was 25.
"I spent a lot of time discussing it with family and the medical team.
"I grieved for my body and struggled with the impact it had on my body image. But I knew it was the right thing to do."
"I remember on the morning of the surgery, I was preternaturally calm about everything," Howie continues. "I kept thinking: ‘I’m in a healthy body and I’m going to have some of that body amputated’ but it was for an empowering reason.
"When I woke up, I felt such mixed emotion – a wave of relief that it was all over and I no longer had a ticking time bomb inside me. But then, of course, there was pain, tears and waves of sadness."
Howie’s surgeons had removed both breasts but had inserted implants – made partially of silicone and saline – under her pectoral muscles.
Over the next 12 months, she underwent a procedure to gradually pump in more saline to make her new breasts ‘grow’ to slightly bigger than her natural size.
"The operation had been a success but I felt completely insecure in my own body," she says. "I went from being a young woman who could walk into a shop feeling confident to some quite distressing incidents where I felt I couldn’t find anything other than ugly bras that would only suit someone’s grandma. I shed many tears in changing rooms."
Watch: A breast cancer survivor finally feels "complete" after getting new nipples tattooed
"Towards the end of 2019, while I was planning my wedding, I wanted to find underwear that I’d feel beautiful in and would make me feel confident on the day and on our honeymoon. But I couldn’t find anything.
"I felt I’d been abandoned by the lingerie industry, as if they’d written off women like me as no longer sexy."
It inspired Howie, a former lawyer, to create her own range – Valiant Lingerie – which launched in the first lockdown last year.
Every model she uses in her advertising is a woman who has had a mastectomy.
"It was so important to me to use women who had been through surgery because when I was having my breasts removed, I never saw any women like me in photographs and didn’t know what to expect," she says. "I’ve designed all our products to be sensitive to post surgery bodies.
"There are certain things you have to consider. For instance, I can no longer wear underwired bras.
"I’ve created pockets in the bras so women can use breast prostheses if they haven’t had reconstruction. Similarly, women who have had lumpectomies – or their reconstruction is not quite symmetrical – can add more padding.
"The material has to be super soft because some women have scars or radiation therapy which makes the skin very sensitive.
"The feedback has been overwhelming. Women tell me that cancer and chemotherapy has stripped away things they associate with their femininity. They’ve lost their hair, their eyelashes, their breasts.
"So, to be able to buy lovely matching underwear and to feel beautiful and sexy again, really helps boost their self-esteem. Their emails have moved me to tears.
"It’s been a huge learning curve but I hope I’ve been able to draw on my own experience to help more and more women like me in the future."
Watch: Woman undergoes double mastectomy after finding her birth mum