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Prophylactic Mastectomy

10:26 17 September in Breast Cancer

This is a hot topic at the moment from many perspectives.

Why would a healthy woman ever decide to voluntarily remove both her breasts? Well if those breasts are genetically pre-programmed to produce cancerous tumours, then surely the wise adage “prevention is better than cure” has never been more true.
Genetic research has conclusively proven that the presence of certain genes in one’s genetic “library” is practically a guarantee that the breast tissue WILL develop cancer within one’s life-time.

What is less certain is the age at which such malignant transformation will occur. In some instances with certain gene combinations, the onset of cancer can be at or before the age of 30 years.

In simplest terms, removing ALL THE BREAST TISSUE is the only way to remove ALMOST ALL THE RISK.

If done electively (before cancer develops), one has the maximum number of options available for immediate reconstruction, and the best chance of saving both nipples, all the skin, and producing an optimal and symmetrical result for both breasts. It is often even possible to produce a more desirable breast shape and size than before the surgery. Once cancer is present however, many of these options fall away, particularly if radiotherapy (and to a lesser extent chemotherapy) is necessary, or if removing the nipples, the armpit lymph glands and/or portions of the breast skin-envelope are going to be part of the surgical plan.

So how is this relevant to you- The woman reading this and wondering if you might be sitting on the proverbial “ticking time-bomb”?

Your family history is a good place to start.

One or more family members who has developed breast cancer before the age of 60 years would be a warning. Siblings with cancer or 2 successive generations with cancer makes an even stronger case for your genetic information to be analysed.

The BRCA 1 and BRCA 2 genes are the most reliable predictors of a pre-programmed, genetically driven breast cancer, and their presence makes mastectomies essential (rather than a choice), as women with these genes have in excess of 80% likelihood of developing breast cancer. In our country, there is a “South African Specific” version of these genes which is easy to test for at any pathology laboratory. Until recently this technology was only available at large academic hospitals but now it is freely available.

As the saying goes, “knowledge is power”, so if you have any suspicions that you might be at risk, ask your doctor (GP or specialist) for their opinion as to whether you should be referred for genetic testing. You can even simply take yourself to the lab and ask to be tested if you have already decided that you want to know your risk.

Please note however, a negative test, doesn’t mean your risk is low – EVEN WITHOUT THE GENE, if numerous women in your family have had breast cancer, you may still have an increased risk from OTHER genetic factors that cant (yet) be tested for.

The highly publicised “Angelina Jolie” case illustrates the point very well. A gene-positive, healthy women who takes the bold pre-emptive step of bilateral prophylactic mastectomy and immediate reconstruction to prevent the near-certainty of breast cancer developing some time in her future.

For the cancer surgeon, it’s the easiest mastectomy possible, and for the reconstructive surgeon, the safest, most predictable and most aesthetically pleasing reconstruction he is likely to do.

So in summary- If this little essay has made you think, or indeed made you concerned for yourself or somebody you know, PLEASE, in the interests of wellbeing, longevity and peace of mind, GET ADVICE, GET TESTED, and help us help you and yours to live your BEST life, embracing health and vitality, form and function, and BALANCE IN ALL THINGS.

Jonathan Toogood