Deciding on a Mastectomy to Reduce Cancer Risk

Eileen Bailey Health Guide
  • This week Angelina Jolie told the world she had a double mastectomy, not because she had cancer, but because she wanted to prevent, or at least greatly reduce her risk, of future cancers. Jolie’s mother died of ovarian cancer in 2007 after a 10 year battle with cancer. As a result, Jolie was tested to see if she had a mutated BRCA1 gene, which increases your chance for developing breast, ovarian and other types of cancers. According to Jolie, “My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.” [1] Although it was a difficult decision, having a double mastectomy has reduced her risk of developing breast cancer to less than 5 percent.

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    BRCA1 and BRCA2 and Cancer Risks


    BRCA1 (and BRCA2), which stands for breast cancer susceptibility gene 1 and 2, are human genes that help to suppress tumors. Mutations of these genes, however, do the opposite and are associated with an increased risk of breast and ovarian cancer, often before menopause. BRCA1 may also increase the risk of other cancers, such as cervical, uterine, pancreatic and colon cancer. BRCA2 may increase the risk of pancreatic, stomach, gallbladder, bile duct cancer and melanoma.

     

    Men can also have mutations of these genes and their risk for cancer increases as well. Men with BRCA1 may have an increased risk of breast, pancreatic, testicular and prostate cancer. BRCA2 may increase the risk of breast, pancreatic and prostate cancer.

     

    For those with a family history of breast or ovarian cancer, the risk increases. Although Angelina Jolie was estimated to have an 87 percent risk of developing breast cancer, the risk is different for each women.  The National Cancer Institute states that approximately 60 percent of women with mutated BRCA1 or BRCA2 will develop breast cancer and between 15 and 40 percent will develop ovarian cancer. [2]

     

    Genetic Testing for BRCA1 and BRCA2


    While there are no standard recommendations for who should have genetic testing for the BRCA1 and BRCA2 harmful genes, “women who have a relative with a harmful BRCA1 or BRCA2 mutation and women who appear to be at increased risk of breast and/or ovarian cancer because of their family history should consider genetic counseling to learn more about their potential risks.” [3]  They also suggest that the person in the family with cancer could be tested first and, if found to have the harmful genes, other family members could be tested.

    Unfortunately, insurance companies don’t always pay for the genetic testing and it is quite expensive, up to $3,000.00 according to Jolie. If you are interested in the testing, it would be wise to first contact your insurance company to find out if any portion of the testing will be paid through insurance.  Then, talk with your doctor about the testing procedures and the costs.

     

    After The Testing


    Not all women with a positive result with develop breast or ovarian cancer. And women who test negative can still develop these cancers. Even so, knowing that you have the harmful gene can help you make decisions about your life. Angelina Jolie chose to have a double mastectomy but that isn’t the only option.

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    Additional options include:

     

    Vigilance in cancer screening - Mammography and clinical breast exams are crucial in finding breast cancer in its early stages, when it is treatable. For ovarian cancer, screening methods include transvaginal ultrasound, blood tests and clinical exams. These methods, however, don’t decrease your risk of developing cancer.

     

    Surgery – “At-risk” tissue is removed to reduce your chances of developing cancer. Jolie, because her risk of developing breast cancer was higher than for ovarian cancer, she decided to have a mastectomy. Your risks may be different. Besides removal of breast tissue, your doctor may recommend removal of the fallopian tubes and ovaries.

     

    Chemoprevention -  Some drugs have been shown to reduce the risk of developing breast cancer or preventing it from recurring. Most studies have looked at overall rates of breast cancer, not just those with BRCA1 and BRCA2 and found the risk was reduced by about 50 percent. The few studies that looked at only those with the harmful genes found about the same reduction.

     

    Lifestyle changes – A number of lifestyle choices may increase your risk of developing cancer. Obesity, lack of physical activity, consumption of alcohol and diet are all associated with higher rates of cancer. Making changes such as eating a healthy low-fat diet, increasing exercise and cutting down or avoiding alcohol may help lower your risk of developing breast, ovarian and other types of cancer.

     

    You should talk with your doctor or a genetic counselor both before and after having genetic testing done. These medical professionals can help you decide whether testing is right for you and, after the testing, work with you to determine which options are best for you.

     

    References:

     

    “Angelina Jolie Undergoes Double Mastectomy,” 2013, May 14, Ed Payne, CNN News


    [2] “BRCA1 and BRCA2: cancer Risk and Genetic Testing,” Reviewed 2009, May 29, Staff Writer, National Cancer Institute

     

    [1] “My Medical Choice,” 2013, May 14, Angelina Jolie, The New York Times

     

Published On: May 15, 2013