Here you have an article about the double preventive mastectomy. Maybe it seems you familiar because it is the operation that Angelina Jolie did. Here they explain you what type of patients are advised, types of surgery, risks, alternatives to surgery ...
After you read it, would you recommend to your patients? What if the patient is not in the high-risk group but wants to be operated? Would you recommend to a young girl who wants to have children in the future?
Hope you like it!
Surgery to Reduce the Risk of Breast Cancer
1. What kinds of surgery can reduce the risk of breast cancer?
Two kinds of surgery can be performed to reduce the risk of breast cancer in a woman who has never been diagnosed with breast cancer but is known to be at very high risk of the disease.A woman can be at very high risk of developing breast cancer if she has a strong family history of breast and/or ovarian cancer, a deleterious (disease-causing) mutation in the BRCA1 gene or the BRCA2 gene, or a high-penetrance mutation in one of several other genes associated with breast cancer risk, such as TP53 or PTEN
The most common risk-reducing surgery is bilateral prophylactic mastectomy (also called bilateral risk-reducing mastectomy). Bilateral prophylactic mastectomy may involve complete removal of both breasts, including the nipples (total mastectomy), or it may involve removal of as much breast tissue as possible while leaving the nipples intact (subcutaneous or nipple-sparing mastectomy). Subcutaneous mastectomies preserve the nipple and allow for more natural-looking breasts if a woman chooses to have breast reconstruction surgery afterward. However, total mastectomy provides the greatest breast cancer risk reduction because more breast tissue is removed in this procedure than in a subcutaneous mastectomy
Even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed. The chest wall, which is not typically removed during a mastectomy, may contain some breast tissue, and breast tissue can sometimes be found in the armpit, above the collarbone, and as far down as the abdomen—and it is impossible for a surgeon to remove all of this tissue.
The other kind of risk-reducing surgery is bilateral prophylactic salpingo-oophorectomy, which is sometimes called prophylactic oophorectomy. This surgery involves removal of the ovaries and fallopian tubes and may be done alone or along with bilateral prophylactic mastectomy in premenopausal women who are at very high risk of breast cancer. Removing the ovaries in premenopausal women reduces the amount of estrogen that is produced by the body. Because estrogen promotes the growth of some breast cancers, reducing the amount of this hormone in the body by removing the ovaries may slow the growth of those breast cancers.
2. How effective are risk-reducing surgeries?
Bilateral prophylactic mastectomy has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a deleterious (disease-causing) mutation in the BRCA1 gene or the BRCA2 gene and by up to 90 percent in women who have a strong family history of breast cancerBilateral prophylactic salpingo-oophorectomy has been shown to reduce the risk of ovarian cancer by approximately 90 percent and the risk of breast cancer by approximately 50 percent in women at very high risk of developing these diseases
3. Which women might consider having surgery to reduce their risk of breast cancer?
Women who inherit a deleterious mutation in the BRCA1 gene or the BRCA2 gene or mutations in certain other genes that greatly increase the risk of developing breast cancer may consider having bilateral prophylactic mastectomy and/or bilateral prophylactic salpingo-oophorectomy to reduce this risk.Other women who are at very high risk of breast cancer may also consider bilateral prophylactic mastectomy, including:
o those with a strong family history of breast cancer
o those with lobular carcinoma in situ (LCIS) plus a family history of breast cancer (LCIS is not cancer, but women with LCIS have an increased risk of developing invasive breast cancer in either breast.)
o those who have had radiation therapy to the chest (including the breasts) before the age of 30 years—for example, if they were treated with radiation therapy for Hodgkin lymphoma
4. What are the potential harms of risk-reducing surgeries?
As with any other major surgery, bilateral prophylactic mastectomy and bilateral prophylacticsalpingo-oophorectomy have potential complications or harms, such as bleeding or infection. Also, both surgeries are irreversible.Bilateral prophylactic mastectomy can also affect a woman’s psychological well-being due to a change in body image and the loss of normal breast functions. Although most women who choose to have this surgery are satisfied with their decision, they can still experience anxiety and concerns about body image. The most common psychological side effects include difficulties with body appearance, with feelings of femininity, and with sexual relationships. Women who undergo total mastectomies lose nipple sensation, which may hinder sexual arousal.
Bilateral prophylactic salpingo-oophorectomy causes a sudden drop in estrogen production, which will induce early menopause in a premenopausal woman (this is also called surgical menopause). Surgical menopause can cause an abrupt onset of menopausal symptoms, including hot flashes, insomnia, anxiety, and depression, and some of these symptoms can be severe. The long-term effects of surgical menopause include decreased sex drive, vaginal dryness, and decreased bone density.
5. What can women at very high risk do if they do not want to undergo risk-reducing surgery?
Some women who are at very high risk of breast cancer (or of contralateral breast cancer) may undergo more frequent breast cancer screening (also called enhanced screening). Enhanced screening may increase the chance of detecting breast cancer at an early stage, when it may have a better chance of being treated successfully.Women who carry mutations in some genes that increase their risk of breast cancer may be more likely to develop radiation-associated breast cancer than the general population because those genes are involved in the repair of DNA breaks, which can be caused by exposure to radiation. Women who are at high risk of breast cancer should ask their health care provider about the risks of diagnostic tests that involve radiation (mammograms or x-rays). Ongoing clinical trials are examining various aspects of enhanced screening for women who are at high risk of breast cancer.
Chemoprevention (the use of drugs or other agents to reduce cancer risk or delay its development) may be an option for some women who wish to avoid surgery. Tamoxifen, andraloxifene have both been approved by the FDA to reduce the risk of breast cancer in women at increased risk. Whether these drugs can be used to prevent breast cancer in women at much higher risk, such as women with harmful mutations in BRCA1 or BRCA2 or other breast cancer susceptibility genes, is not yet clear, although tamoxifen may be able to help lower the risk of contralateral breast cancer among BRCA1 and BRCA2 mutation carriers
Source: http://www.cancer.gov/cancertopics/factsheet/Therapy/risk-reducing-surgery
Inma Morcillo
Congrats!! It´s a good article,and Angeline Jolie is an enterprising woman.
ResponderEliminarBreast cancer sounds hard,I don´t know but cancer must be like a nightmare.All of us are women so maybe for us it´s better to understand women with breast cancer.
Cancer involves too much time in the hospital,bettween doctors and nurses,thinking in your childs and husband...It´s not better to avoid all theses things,enjoying our life and our relatives´life if we can do it?
If we´re doing investigations and we´re discovering new methods,methods that are working we need to use them.Sometimes it´s complicated,and of course all cases are not equal but I think that it´s a good option a double preventive mastectomy.
A double preventive mastectomy it´s a good option and for me better than vaccines like vaccine against human papiloma virus that can cause future problems.It´s something demostrate and it can save moeny for hospital and sadnedd and suffering for women.
What do you think? Imagine that you are in the situation,imagine that you have possibilities,will you do it or not?
Hi girls!
ResponderEliminarFirst of all, I want to congratulate Inma on have chosen this article, because I think it's a interesting and present-day topic.
From my point of view bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy is a good option for patients who have mutation in the BRCA1 gene or the BRCA2 and they have very high risk of developing these disease. NOT for every patients.
Why? What Miriam says is true: Cancer is very hard, it involves too much time in the hospital... and the best option would be avoid it and enjoying our life and our relative's life if we could do it. Unfortunately, I think we can't do it.
Having a mutation in BRCA 1 or BRCA 2 doesn't mean that patient will have cancer. She can have or not.
Bilateral prophylactic mastectomy and bilateral prophylacticsalpingo-oophorectomy are major surgeries, and they have complications. They also have adverse psychological effects: difficulties with body appearance, with feelings of femininity, with sexual relationships...
For all these reasons, I think that the best option in patients with low risk is screening and follow-up by means of mammogram.
In patients with high risk the risks and benefits must be assessed, and if surgery is the best option, just do it.
To conclude, I would like to emphasize that each person is different, is no way to predict what will happen. For this reason patient's wishes should be listened and taken into account. She should be able to decide what treatment she wants.
I would like to know your views about this.
Thanks!
hi girls!
ResponderEliminarto begin, i want to say that it is a very interessant issue, because it is very controversial; there are a lot of diferents opinions and ways to see it, every one with their own reasons, for being against or for this prophylactic intervention.
Essentially, the problem is that this intervention could benefit or not the women interventioned.
on the one hand, if the interventions is done, she is not 100 % protected from cancer, and what's more, we don't know if she would have developed the cancer in ehr live.
on the other hand, the time, money and doctords spended in this intervention could be have been used to traet a real cancer.
Breast cancer has a very successful treatment, as well as follow-up and early diagnosis.
The mortality due to breast cancer is decreasing nowadays.
We don't have to forget that the interventions includes not onli the resection of both breasts, but also the reconstruction. we neither have to forget the riscs that an intervention implies, for the surgical technical, and also the anesthesia.
I think the decision of being intervencioned must be done, by all the doctors implied and the patient.
In my opinion, this technique should be done, only when there is a clearly benefit of doing it. that implies a very big ( nearly certanly) probability that the patiend would suffer in any time the dissease.
That means in my opinion, to have most of the risc factors, increasing properly the risck of breast cancer.
in fact I really agree with my partners, because, as much issues in medicine, there isn't only a correct response or opinion.
Therefore, in my opinion only the women with a veri high risck should be operated, and the other women, shouls be followed-up, by the actual techniques and protocols.
Finally, I accept that every women have their opinion, and I'm not againt of the techniques, if the patient knows every advantatge and contra, and she decides to be interventioned.
Thank you Inma!
Neus :D
Hi girls!
ResponderEliminarFirst it seems a very interesting topic that has been discussed a lot, as Inma says, following the decision of Angelina Jolie. It is also a topic of considerable controversy and we`ve learned a little more this year on the subject of oncology .
With all this I think that like any other surgery also has a risk , in this case greater. But I also see a good solution for these serious diseases, There have been some studies that has been seen that these surgeries are successful cure of cancers produced by mutacioned BRCA1 and 2 (which are very dangerous). I think it`s very recommended. Of course I also think it's not an easy decision and the patient is with the doctor who must find the best solution for your problem.
On the other hand , we are fortunate that today there are other interventions or methods that may help overcome the problems caused by these radical surgeries. For example, you can make breast implants or you could try to have children through a surrogate mother, in an salpingo-oophorectomy,.
Finally, it is very important matter for the patient so as doctor we must give them all the necessary information in a clear and understandable issue. In order for the patient to understand the risks and complications of these interventions.
Hi girls!
ResponderEliminarI've been doing practice in breast surgery this year and I think this article refers to the key points of this type of cancer, so congratulations Inma! Your choice is very successful because it’s a current topic due the cases of breast cancer are increased everyday. But, fortunately, nowadays it is better known and we have new treatments to combat it.
The article reflects different points of view and it explains the pros and cons of each one.
My opinion is very similar to the opinion of my partners. I think the option of bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy is adequate only for patients with mutations in BRCA 1 and BRCA 2 because they have a high risk to develop breast cancer.
However, the duty of surgeon and oncologist is to explain the patient that not all people with this mutation will develop cancer and that a small percentage of operated patients will develop it despite the surgery.
Also the surgeon have to explain the complications and characteristics of the operation like: it is irreversible, psychological effects, estrogen levels decrease…
For patients without mutation, I think the best option is the screening with ultrasounds and X-ray (mammography) to detect the cancer in initial states because an early detected cancer is smaller and the doctors can offer the patient a moderate treatment preserving the breast.
To conclude I said that the most important of all is to inform correctly the patients and to be empathetic with them because it’s a very impressive and delicate situation.
Hi girls!
ResponderEliminarFirst of all I want to congratulate Inma! Your article has been a success!
The topic of the article I think that it is very interesting because Cancer is a disease which there are more cases every day. Effective prevention is very important, and in recent years much progress is being made in research to prevent any type of Cancer. Despite this progress, Cancer still affect a large part of the population. Who does not know someone who has had cancer?
Regarding the preventive double mastectomy, I think very hard intervention both psychologically and physically to a woman, but at the same time is needed to make a radical preventing breast cancer in women who have mutations in the BRCA1 and BRCA2 genes. But there are other ways to prevent this cancer. These other options are less invasive and you can preserve both breasts. But they are probably not as effective.
For all this, I think the decision to undergo this surgical intervention should be a decision that you should plan with your family and your doctor.
Hi! This article shows the different ways to treat a very common illness like breast cancer is. We are been related some decisions about how to behave in front of breast cancer and what are the prevalence rates before the surgical procedures.
ResponderEliminarOn the one hand, be exposed to an double preventive mastectomy used to report some benefits which are recognized by the patients, but we live in a world where physical appearance is considered most important than really is. Nevertheless, there are persons who ignores that physical appearance and decide be performed a surgical procedure in order to decrease high risk rates that afraid them.
On the other hand, bilateral prophylactic mastectomy and bilateral prophylacsalpingo-oophorectomy surgeries will produce disorders in patients like interruption of sexual behavior or loss of female identity.
Finally, follow a usual check and be performed exams often can be the decision overcome of a person who will be unable to look himself in a postsurgical situation with the signs which are been explained.
Pd: Angelina´s case is such a magnificent fight example, but there exist many others heroin females who are unknown!
Hello everybody! I think this topic is interesting and it makes people think about overcoming cancer.
ResponderEliminarIn my opinion everybody is sensitive to the cancer, but not everybody knows what really means suffering a cancer. When a person is diagnosed of cancer, a sea of problems comes up to him and a change of life too. These people start visiting different doctors of many specialities, such as radiology, oncology…; patients tend to be long periods of sick leave and they fail to follow their routines and hobbies. In addition, the treatment of cancer can be very aggressive and it leaves the patients exhausted, moreover their family are too.
If suffering a cancer is hard for the person who has it, in my point of view it is harder when the cancer affects a part of your body which identifies you as a woman.
Here all physical changes involve great psychic ones, losing breasts in a woman makes her lose her identity as a woman, she stops liking herself and she believes she will not be sexy anymore. It involves changes with the relationship with her boyfriend or husband. As doctors we should be conscious of that and we should offer psychiatric help to these patients, we can propose them to go to therapy groups and introducing women who have been through it.
Finally, I would like to notice that nowadays there are many advances in cancer treatment an every time we beat more it and I hope that we, as doctors, can contribute to this fight.
Hello everyone!
ResponderEliminarFirst of all thank you for your opinions! It has been very gratifying to know what you think about this, and I'm glad you like the article (thanks Marta for saying that was a success).
Miriam believes that cancer is a disease too hard, which involves not only the patient but also their family, so that she supports the use of a preventive double mastectomy. My colleague Ana, on the other hand, says that this operation is not valid for all patients, and that we must be very careful with it. As we say, has a very large impact on self-esteem and relationships for women. Neus thinks should be done only in patients with a high risk because it also involves another operation to reconstruction that also has risks, plus it does not guarantee 100% that cancer does not develop. Bea points out the importance of mammography and screening for early detection of breast cancer. Danae mentions that women has to decide with awareness of possible changes or side effects of surgery. I find it interesting the view of Marta about the double preventive mastectomy is a decision that should involve both the patient and his family and doctors, due to the importance and impact that can have.
All of us have come to the same conclusion I did when I read this article: depending on whether a patient is at high or low risk of breast cancer (based on mutations in BRCA1 and BRCA2, and family history of cancer ), recommend a double preventive mastectomy or not.
I liked that you considered how hard it means for a person to have cancer, and as Julia said, that it be taken into the breast, a sign of femininity of women.
Furthermore, I think is important what Melania said: we as doctors must be clear at the time of passing the information to patients, explaining the advantages and disadvantages involved in such an important operation and the possible consequences that may result from major surgery.
I am delighted to share with you this article and know what you think about a current topic. It has been a pleasure!