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Prophylactic MastectomyRichard Daniels, MD What did Angelina Jolie consider in her decision?The surgical treatment of breast cancer usually involves removing part (lumpectomy) or all (mastectomy) of the breast after a woman has been diagnosed with breast cancer. It is unusual to think about removing one’s breast to prevent the development of future breast cancer. Angelina Jolie has brought this option into the spotlight. She opted to have both breasts removed to possibly prevent the future development of cancer. Was this the right decision?
The risk factors for developing breast cancer may include family history (first or second degree relatives with breast cancer), advanced age, reproductive and menstrual history, hormone therapy use, alcohol intake, physical activity, etc. Most breast cancers develop in a family sporadically (no other family members with breast cancer). Only 5% of breast cancers are genetically passed from parents to their children. Angelina Jolie has a genetic mutation that was passed to her by her parents. This is a change in her DNA or genetic make-up that leads to a marked increase in the development of both breast (56–84%) and ovarian (36–63%) cancer. This change is referred to as BRCA1 and BRCA2 mutations. Both mutations can be detected by a blood test that costs $3,000. Because the chance of having the genetic mutation is very low, some insurance companies may not cover the cost of this test. Women like Ms. Jolie who are positive for this genetic change have several options to help the fight against breast cancer.
All of these options are acceptable and may appeal to women for different reasons. Ms. Jolie opted to have both breasts removed surgically to lower her potential of developing breast cancer. Removing an organ of the body such as the breast with no known disease is called prophylactic surgery. Prophylactic mastectomy, or removal of the breasts, reduces the risk of future breast cancer by 90% in women who have the genetic changes of BRCA1 or BRCA2. Studies show that both the risk of developing breast cancer and the possible future death from breast cancer (if you develop it) is decreased by breast removal.
Dr. Daniels is a surgeon with Evergreen Surgical in Eau Claire. He has a special interest in the surgical treatment of breast disorders. He is a member of the American Society of Breast Surgeons.
Dr. Daniels – Evergreen Surgical |
Ms. Jolie did make the right decision for her. This decision was made with help from her health care providers. Women with a family history of multiple relatives with breast cancer, especially at young ages, should be offered genetic testing. As a medical community we need to make these tests more available and affordable. As patients, I encourage you to be proactive and obtain as much information as possible in regards to your health care. With information comes the power to make informed decisions and envision a very different future for yourselves.