Breast Cancer Prevention by Mastectomy?

Angelina Jolie: Prevent Breast Cancer by Prophylactic Mastectomy?

15/05/2013

Actress Angelina Jolie's prophylactic mastectomy, which became public on Tuesday, has sparked an intense debate over whether breast removal and breast cancer prevention are useful and for whom. The actress first reported publicly yesterday on her mastectomy. In a genetic test, the breast cancer risk gene BRCA-1 was discovered. Also, Angelina Jolie's mother had died of ovarian cancer at the age of 56, indicating a greater family risk.

37-year-old Jolie reports that doctors estimated her breast cancer risk at 87 percent and the probability of developing ovarian cancer at 50 percent. To minimize the risk of cancer, she has therefore decided to amputate the breasts. Although this decision was certainly hard for her, Jolie should have made the step a little easier with the greatly improved surgical options. Today, a mastectomy is often barely perceptible externally. According to the doctors, the surgery has reduced her breast cancer risk to around five percent, according to the actress.

Mastectomy without external changes
After a mastectomy, implants can help maintain the original shape of the breast, and thanks to the improved intervention options, only a few small scars remain, explained Angelina Jolie. Thus, the affected are hardly changed in appearance and then do not have to live with a physical blemish. Accordingly, the decision to undergo a mastectomy today is much easier to make than just a few decades ago. Also, the genetic testing, which allow a determination of risk genes, not so long available. A preventive mastectomy was therefore previously out of the question. The removal of the breast was intended rather as a treatment after breast cancer diagnosis.

Questionable prophylactic mastectomy
Although there is an option today to review the genetic risk of breast cancer, the subsequent decision to prophylactically breed it, due to a risk potential estimated by genetic testing, remains controversial. Especially as an intensive monitoring of the risk patients (half-yearly controls) and a corresponding early intervention in actual breast cancer detection, seem quite sufficient here. The American Cancer Society (ACS) has also pointed out that preventive mastectomy is only useful in very few women. Moreover, this radical measure does not completely rule out the risk of breast cancer, as remnants of the breast tissue remain in the body and could contribute to the development of breast cancer. Those affected should therefore continue to participate regularly in screening programs.

Genetic testing to estimate the risk of disease
The genetic tests are now a widely used diagnostic procedure that can also provide evidence of previously unexplored diseases. For example, women with a high familial breast cancer risk (grandmother, mother or sibling suffering from breast cancer) are recommended to carry out an appropriate genetic test in order to be able to estimate the individual risk of disease. This has happened to Angelina Jolie and the doctors came to the conclusion that the actress would be ill with about 90 percent probability of breast cancer. Comparable genetic tests are also offered in Germany. In approximately ten days, one of the 15 Familial Breast and Ovarian Cancer Centers will be able to conduct a screening.

Good chances of recovery with early detection of breast cancer
However, even the detection of individual risk genes is always an assessment of the cancer risk. Whether the patients would actually contract breast cancer remains open. Thus, the many expressed doubts about the prophylactic mastectomy seem at least partially justified. In particular, if one considers that the treatment options with a very early diagnosis of breast cancer are quite good. Here is expected from a 90-percent chance of recovery. To ensure early detection of the cancer, sufferers must regularly participate in intensified screening programs, but they may be spared a mastectomy in this way. (Fp)

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