Will a double mastectomy improve breast cancer survival rates?
What would make someone remove their breasts? Medhatter asks Dr Wong Seng Weng, Medical Director and Consultant, Specialist in Medical Oncology from The Cancer Centre, a Singapore Medical Group (SMG) clinic, a few questions about mastectomy.
Angelina Jolie underwent pre-emptive removal of both breasts to reduce the likelihood of developing breast cancer as she has inherited the BRCA gene from her mother. This surgery is usually in the form of a skin-sparing mastectomy, ie the breast tissue is removed while the overlying skin is preserved to allow plastic reconstruction of the breasts to be performed.
The surgery requires general anaesthesia and this has associated risks. However, this surgery typically takes place in fairly young women below the age of 50. This group of patients is generally of good health and the surgical complication rate should be low. However, removal of the breasts does potentially carry a psychological impact and patients often feel a sense of loss.
“The nipples may be spared. No milk production is possible as all the milk producing gland sand the ducts carrying milk to the nipple are removed during surgery. Breast reconstruction with an implant is frequently done and does not post a significant health problem.”
“I would generally only recommend this surgery to women who are tested positive for the BRCA gene. A woman with a strong family history of breast cancer should consider testing for this gene before considering the surgery.”
The BRCA 1/2 gene is thankfully rather uncommon and affects about 1 in 200 women in the general population. A female carrier of this gene has a markedly elevated lifetime risk of developing breast cancer (60-80%) as well as cancer of the ovary or fallopian tubes (40-60%). Male carriers have an elevated risk of developing male breast cancer and prostate cancer. Each child of a carrier has 50% probability of inheriting the gene.
Hormonal factors such as early menarche and late menopause increase the risk. Nulliparity or late childbirth after the age of 35 is associated with a higher risk compared with women who gave birth to the first child before the age of 35. Other factors that increase breast cancer risk includes obesity, high red meat consumption and alcohol consumption. Working night shifts is also recognised by WHO as a probable carcinogen in breast cancer.
Childbirth reduces the lifetime risk of developing breast cancer but has to take place before age 35 to have any significant effect. However, there is a transient increase in risk of breast cancer during pregnancy due to the surge in female hormones in the body. New occurrence of lumps in the breast or discharge from the nipple (especially if blood-stained) are suspicious symptoms.
“Angelina Jolie is facing an unusual situation of having inherited a fairly uncommon cancer-causing gene. The surgeries to remove the breasts and subsequently the ovaries and fallopian tubes are justified in her case. Women should not consider such radical treatment for cancer prevention if they do not carry the BRCA gene. Even for women diagnosed with breast cancer, if they do not carry the BRCA gene, breast conserving surgery rather than mastectomy should be considered wherever possible.”