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Removal of both breasts for radical cancer prevention
Breast cancer is the most common type of cancer in women, affecting approximately 70,000 people each year. In about ten percent of cases, genetic predisposition plays a role in the genesis, but there is a special test that can detect appropriate genetic alterations. A positive result means a significantly increased risk and puts the affected woman in the decision about a possible operation. The best known example is Hollywood star Angelina Jolie, who lost both breasts and had their ovaries removed because of their family history. But is such a rigorous step useful? In an interview with the news agency "dpa" experts inform about the possibilities and limits of this procedure.
Less than ten percent of cases are based on high-risk patients
"Can breast cancer be inherited?" Indeed, in a small proportion of patients, genetic predisposition plays a role in the disease. But there is a special test that can detect changes in the genome using a blood sample. A positive result indicates a significant increase in risk and raises many concerns and uncertainties for the women affected. "Should I have my breasts removed as a precaution or not?" This question can only be answered by the woman herself and usually requires an intensive decision-making process.
The Breast Cancer Genetic Test is performed on a blood sample and is only recommended for women who actually have a family history of breast cancer. Because this only applies to a small proportion. Accordingly, of the approximately 70,000 women who develop breast cancer each year, less than ten percent would be based on high risk genes, said Kristin Bosse from the Center for Familial Breast and Ovarian Cancer at the University Hospital Tübingen to the "dpa".
German consortium for familial breast and ovarian cancer sets nine criteria
In order to be able to define whether a person has a genetic predisposition, the German Consortium for Familial Breast and Ovarian Cancer has set nine criteria, of which at least one must be met. Thus, there is an increased risk e.g. if in the family three women - regardless of age - have breast cancer or two women have ovarian cancer. The same applies if a woman before the 36th Birthday gets breast cancer or a woman in the family suffers from breast and ovarian cancer. "You need such evidence," explains Prof. Christof Sohn from the University Women's Hospital Heidelberg. If these were present, it could be started with the diagnostics.
Altering one of the two BRCA genes means significantly increased risk
In the test, especially the genes "BRCA1" and "BRCA2" are of interest, which would be examined for possible changes, explains Christian Albring from the professional association of gynecologists. The term "BRCA" stands for "BReast Cancer", which originates from English and means breast cancer. If the test is positive, however, it can not be determined with certainty whether and when the disease breaks out. Nevertheless, a change in one of the two BRCA genes significantly increases the risk of developing breast and / or ovarian cancer.
According to the study, with an altered BRCA1 gene, on average between 60 and 80 out of 100 women would develop breast cancer during their lifetime. In the case of an altered BRCA2 gene, the risk for ovarian cancer would be 10 to 20 and for breast cancer 45 to 80 percent, Albring continued. "Without these changes, the risk of ovarian cancer is 1.5 percent and the risk of breast cancer is 10 percent."
As Kristin Bosse reports, many women now use the test to clarify their health status. The fear of a positive outcome would rarely stand in the way, because "ignorance in the medium and long term is no better than to endure the knowledge and the associated opportunities to act." Also Cindy marshmallow, who for the Psycho-oncological service with Working together with the Cancer Center Dresden confirms the high willingness of patients to be tested in order to know their personal cancer risk.
A positive test is followed by a close-meshed screening program
If there is a positive result, the risk patients will be followed by intensified screening programs, which, depending on their age, will include different procedures, such as Palpation, ultrasound, mammography or endoscopy. "You can not prevent cancer, but discover it early," says Prof. Christof Sohn. According to Kristin Bosse, the examinations should be carried out in one of the 15 university centers of the German consortium for familial breast and ovarian cancer. Because here the affected women could at the same time through preventive measures such. a decrease in the breasts will be advised.
However, this is a process that must "happen in one," continued Prof. Sohn. Because before such a step are many questions and concerns in the room, which, according to Cindy Marshmallow would have to be clarified. Thoughts such as "How is the result?" Or "What does my partner say?" Would be discussed in advance with psycho-oncology staff. Partly it would also come to meetings with women who had the procedure already behind, explains marshmallow.
According to Kristin Bosse, there is an increase in the number of interventions, especially in the precautionary removal of mammary gland. One of the reasons for this is that only in this way can the cancer risk be maximally reduced, and in addition the cosmetic results are getting better and better. However, despite the medical advances, women should be aware of the change, according to the expert, because "one always wakes up with a reconstructed breast."
Precautionary removal of the ovaries usually takes place only from the age of 40 years
By contrast, a precautionary removal of the ovaries hardly plays a role in younger women and is usually recommended only from the age of 40. From then on, the risk increases more clearly, but only about three to four percent of women with an altered BRCA1 gene under 40 would develop ovarian cancer. If the ovaries are removed, according to Albring "a situation similar to the menopause", as no more estrogen and progestogens are produced. To prevent menopausal symptoms and osteoporosis, hormone replacement therapy can help some women. "It is more difficult for those who have ever had breast cancer," explains Albring, because the administration of hormones should not happen here without further ado. Typical complaints such as However, sleep disorders in these cases could be treated, for example, by non-hormonal drugs. (No)