For many women, undergoing a double mastectomy is a deeply emotional and intimate experience. A patient must make the dramatic and difficult choice to surrender a natural part of herself that is very much aligned with her feminine identity. Oftentimes, this decision is considered a lifesaving treatment for breast cancer. But, as the public was reminded recently, the procedure can also serve as a preventative measure to reduce the risk of developing the disease for those at a high risk.
Angelina Jolie’s announcement that she received a preventative double mastectomy to reduce her chance of developing breast cancer from 87 percent to less than 5 percent shined a powerful light on the procedure. Jolie carries an alteration (called "mutation") in a gene called BRCA1, which greatly increases her lifetime risk of developing breast cancer. Her mother died at age 56 from ovarian cancer, which also increases the risk for someone who carries the BRCA1 mutation to develop cancer.
While it is not an easy decision to make, preventative double mastectomy is the most effective way to maximally reduce the risk of developing the disease for those who carry a gene mutation. The bold choice results in a greater than 90 percent chance that the patient will not get breast cancer. There is no medicine that will reduce a patient’s risk to that degree. And, with innovations in medical technology, the cosmetic reconstruction of breasts has improved greatly.
According to my colleague Dr. Lifei Guo, chairman of plastic and reconstructive surgery at Lahey, breast reconstruction following a mastectomy is typically performed in a staged approach, whether or not the patient receives implants or autologous tissue (tissue mostly from her own abdomen) to rebuild the breast. In selected cases however, single stage reconstructions can be feasible depending on several treatment and patient factors. At Lahey, we offer a full spectrum of breast reconstructive options. The completion of a full mastectomy and reconstructive process can be immediate, as in Jolie’s case, or it can take as long as 18 months. Also, while the reconstructed breasts will no longer be sensual, the end result often appears realistic and is cosmetically pleasing.
Preventative double mastectomy and reconstruction surgery is recommended for patients who carry either a mutation in the BRCA1 or BRCA2 gene (as well as some other hereditary breast cancer genes). No data suggests that this procedure is beneficial for those who are not at a high risk to develop breast cancer.
While Jolie’s brave announcement has brought the issue of preventative surgery to the forefront, it is important that people understand that a very small number of people actually carry one of the genetic mutations: only about five to 10 percent of breast cancer is due to a hereditary cancer gene. While the chances to develop breast cancer are greatly increased with a BRCA1/2 mutation, it is important to realize that some women never go on to develop cancer. Breast cancer is a disease of aging, meaning the number one risk for breast cancer is a woman’s age.
For those who think they could be at high risk for breast and ovarian cancer based on their personal or family histories, it is important to seek risk assessment and genetic counseling. Rebecca Hodges, a certified genetic counselor in our familial cancer risk assessment center, recommends patients to consider testing if they have a variety of risk factors, such as a family member who developed breast cancer under the age of 50, a family member who had ovarian cancer, a family member who had both of these diseases, or a male relative with a history of breast cancer. If you would like to learn more about our genetic counseling services and other risk factors, please visit Lahey.org/FCRAC.
I hope that Jolie’s story will encourage women everywhere to look into their options and feel comfortable speaking with their doctor about their risk. After all, the advances in risk assessment and surgical procedures offer women at high risk something that was not always available: a choice.
Dr. Rebecca Yang is the director of Lahey Hospital and Medical Center’s Comprehensive Breast Health Center. Lahey Health offers primary care services in Billerica at 267 Boston Road, Suite 20 in North Billerica.
This is an excerpt taken from the Billerica Minuteman.