Preventative mastectomies unnecessary for some at-risk women

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Dr Carol-Ann Benn, a specialist surgeon and breast disease specialist, who established the Breast Care Centre of Excellence at Netcare Milpark Hospital, cautions women who have a genetic risk to breast cancer not to rush to have both their breasts removed as a way to prevent the disease.

"Risk reduction surgery should only be discussed with women who consider themselves to be of high risk. Again it should be offered in multidisciplinary units, after careful consideration is given to all the disadvantages of the procedure and should never be offered as an emergency," she observes.

Women diagnosed with breast cancer may elect to have mastectomies but the procedure is not for all women and once a diagnosis of breast cancer has been made, a non-hurried multidisciplinary approach should be taken for all those diagnosed.

BRCA1 gene mutation uncommon

Dr Benn further points out that the genetic mutation known as BRCA1, for which Jolie tested positive, is uncommon. "Less than 10% of women with breast cancer have BRCA1 and another gene called BRCA2. Those who test positive for BRCA1 or BRCA2 have a 50% - 80% chance of developing breast cancer. To test for the BRCA gene requires an index case ie a living relative with breast cancer who has tested positive for the gene. A negative BRCA test in an index case however does not exclude genetic (inherited) breast cancer, but merely our inability to detect the causative gene or gene combination."

She highlights that BRCA mutations are more prevalent in Jewish women of Ashkenazi (Eastern Europe) descent, African American women, Afrikaners (Dutch descent), and women of Scottish and Hispanic descent. Nevertheless, she adds that genetic mutations can occur in any racial or ethnic group.

Dr Benn recommends, "Before you decide to have your breast tissue removed, visit a unit that offers multidisciplinary care, including psychological counselling and the best possible advice as there are multiple options which can be used to decrease risk including close screening, risk reducing medication and surgery."

Surgery can only proceed after intensive counselling and assessment of all risks has taken place, particularly the patients' personality, anxiety and cancer fear.

Women considering risk reduction surgery should note that at the time of breast tissue removal, reconstructive procedures should also take place.

"Deciding to have risk reducing mastectomies is a difficult decision; which can be rewarding in women that fit the criteria. The Prose Study Group, Rebbeck et al, measured the incidence of breast cancer in 483 BRCA1/2 mutation carriers. The data indicated that bilateral prophylactic mastectomy reduces the risk of breast cancer by approximately 90%," concludes Dr Benn.