Many women are afraid of their own breasts

Many women have a genetic test for fear of cancer
Almost three years ago, US actress Angelina Jolie was removed from both breasts due to a high risk of genetically-induced breast cancer. A drastic step, which triggered a wave of inquiries at German clinics and breast centers. The need for advice is still great today and more and more women are being genetically examined for fear of cancer.
Breast amputation with Angelina Jolie beats high waves
Breast cancer is the most common type of cancer among women, which affects approximately 70,000 people each year. In five to 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 the actress Angelina Jolie, who, due to her family history less than three years ago, had both breasts removed and her ovaries removed.
The fear of breast cancer: More and more women are afraid of their own breasts. Picture: Eskymaks-fotolia
The case of the well-known Hollywood star triggered a rush of calls and inquiries in 15 centers around the world that specialize in familial breast and ovarian cancer. Many women asked about the possibilities of a check-up, explains Claus Bartram, director of the Institute of Human Genetics at the University Hospital Heidelberg, to the news agency "dpa". But much of it would have worried in vain, as they had no family history of breast cancer, Bartram went on to say. Because this only applies to a small proportion.

Only five to ten percent of the diseases are hereditary
One in ten women will develop breast cancer during their lifetime, but there are two gene mutations that can increase the risk of disease by as much as 80 percent. The risk genes are referred to as "BRCA1" and "BRCA2", whereby the term "BRCA" stands for "BReast Cancer", which means from English and means breast cancer. If one of the two genes is altered, the likelihood of other tumors such as ovarian and pancreatic cancer also increases. About one-third of hereditary breast tumors would be caused by the already discovered in 1994 and 1995 mutations, according to Bartram - but only a small proportion of about five to ten percent of new cases is hereditary.

Breast cancer is still the most common form of cancer among women in Germany. According to the Robert Koch Institute, around 70,000 new people suffer from it each year, and around 17,500 women die each year. One in four sufferers is younger than 55, and one in ten is even under 45. Ovarian cancer is diagnosed annually at around 7,800 women, but health experts have repeatedly suggested that ovarian cancer is more dangerous than breast cancer because it is less recognizable. For many affected women, therefore, any help comes too late, about 5800 women die each year from the tumors.

Detailed advice before the genetic test important
Therefore, a gene test can be useful if, for example, the mother and grandmother already have breast cancer in a family, resulting in a greatly increased risk of cancer. However, the investigation costs 3,000 euros and not all health insurance companies take over the costs, since in the end no disease, but only an estimated probability is detected. For Bartram a difficult situation, because in his view, it should not be withheld from anyone, "preventive and self-determined to act". According to this, standardized, less expensive procedures are needed, with which female relatives can be tested in a more targeted manner, if there is already a positive result in the family. It looks a bit different with the substitute health insurance companies, because they would pay for the test if there was a suspicion of hereditary breast and ovarian cancer, explains Michaela Gottfried from the Verband der Ersatzkassen (vdek). "The analysis can mean clarity for a family combined with an intensive consultation," the spokeswoman continues.

If a woman wants to have the test carried out, she should, however, get detailed advice in advance. If the result is positive, the woman faces a difficult decision. According to Bartram, it is important to be able to analyze the individual situation of those affected before the examination in order to handle the test results responsibly. Also dealing with a negative result must be considered, because "some people respond to the test result with guilt. For example, because the own sister or mother carries the BRCA mutation, but the patient herself has been spared, "explains the expert.

Deciding on the next step is usually very difficult
The BRCA test usually yields a clear result despite thousands of different mutation variants. Only in about five to ten percent of the investigations, the mutation found could not be estimated according to a possible dangerousness, according to Bartram. If a woman carries one of the gene mutations in her genome and has a significantly increased risk of cancer, she can opt for a preventive surgery. This not only affects the amputation of the breast (mastectomy), but also fallopian tubes and ovaries can be removed. Angela Jolie decided to take this step in the spring of 2015 and, as a precautionary measure, had her ovaries removed after estimating the risk of ovarian cancer at 50 percent.

Women rarely opt for a precautionary breast amputation
But the decision for or against an amputation can be extremely difficult for those affected, because no one can say with certainty whether the woman is actually suffering from cancer in the course of her life. According to Ditsch, only a few of the women would ultimately opt for a preventive breast reduction. "We recommend a removal of the ovaries and fallopian tubes, however, in general mutation carriers from 40 years," said the Munich cancer expert. Because of this intervention, the risk of cancer in this area would fall from 25 to 55 percent to about 2 percent - an important step, precisely because in many cases the ovarian cancer is discovered late and therefore more difficult to treat.

In addition, affected women could benefit from the procedure otherwise, because "the removal of the ovaries causes significant hormonal changes in the body, as the menopause is triggered prematurely," explains Ditsch. This also significantly reduces the likelihood of breast cancer, and possible menopausal symptoms such as hot flashes can then be treated well with the help of artificial hormones, according to the expert. (No)