Back in Shape, Breast Reconstruction



Double Mastectomies Are Trending, But What's the Benefit?

BRCA Screening Suggested for Higher Risk Women

The increase in genetic testing was “appropriate” according to the authors of the study: “These were not inappropriate people who had somehow been frightened or alarmed by the messages that came forward; rather, because of their clinicians' or their own awareness, these were perfectly appropriate individuals who should be getting genetic counseling who were seeking that genetic counseling.... It's a real triumph for what a public disclosure of a health problem can accomplish for patients and society."

Previous studies have assessed risk in women with a personal or family history of cancer. In the new research, Mary-Claire King and colleagues identified women carriers of the BRCA mutations regardless of family history.

In a controversial new Israeli study, authors recruited more than 8,000 healthy menwho were Ashkenazi Jews, a group at high risk for the BRCA mutations. They found 175 male carriers who were previously unaware of their risk status.

More than 600 female relatives of the male carriers were then screened for the mutations, and more than a third of those 211 women were identified as carriers. About half of these families withBRCA1orBRCA2mutations had no significant history of breast or ovarian cancer.

Population Screening for BRCA Mutations

When an inherited  BRCA mutation is discovered, women can proactively avoid the future risk of ovarian and breast cancer by undergoing surgical interventions. The choices include removing the ovaries after child bearing years, and prophylactic mastectomy. The authors suggest that not only women in high risk groups, such as those with Ashkenazi Jewish lineage would benefit. They say that a population-wide screening for the genes might be successful in identifying individuals at higher cancer risk in the general population.

Another finding was that women born after 1958 were almost four times more likely to develop breast or ovarian cancer by age 50 than those born before 1958. Possible explanations for this include more effective mammography, non-genetic, environmental risk factors, and others. This might explain the “young women” effect that we are now seeing with the apparent surge in women developing breast cancer in their 40s. It suggests that population-wide screening forBRCA1 and BRCA2mutations is feasible. Screening may help identify women at high risk who would not have been identified by screening based only on family or personal history of cancer, according to the authors.

Double Mastectomy Trending Upwards

I have always had the mindset that more information leads to better choices. “Not wanting to know” just doesn’t seem acceptable anymore. This is especially true now that we have new innovative reconstructive procedures and trained, skilled breast and plastic surgeons.

In a new trend, more women under the age of 40 in California were choosing to have double mastectomy over just treating the single breast affected by cancer, according to a study in the Journal of the American Medical Association on September 3, 2014. However, the study found that the rate of dying from breast cancer was the same for women who chose double mastectomy as for women who chose lumpectomy and radiation of just the affected breast. In the same study, the highest mortality rate was found in women who chose to only have a single mastectomy. The authors suggest that the use of sensitive testing such as MRI and genetic testing of younger women diagnosed with breast cancer may lead to the decision of either surgery with minimal cosmetic impact—lumpectomy and radiation, or surgery and reconstruction of both breasts to gain a symmetric result.

For a young women diagnosed with breast cancer, it is wonderful to have treatment options. Great cosmetic outcome matters with either choice. It’s hard to explain the increase in death rates in women with a single mastectomy, removing only the cancerous breast. It is possible that these patients had more advanced local disease at presentation. Clearly, further research and study are needed.

Three generations of women in my family have had breast cancer.  When my mother developed the disease in her 40's, the BRCA gene hadn’t yet been identified. Had it been, she would very likely have gotten the test, because of her Ashkenazi Jewish heritage. She got the test as soon as it was available, though, and was negative, even though it is very likely that she had some genetic predisposition for the disease.

Today, when a woman is diagnosed at a young age or has a family history of breast or ovarian cancer, she is in many cases offered the test.  Research has shown that as time goes on we are less frightened by the prospect of a positive test.

I guess we can say, “we’ve come a long way baby,” but we certainly still have a long way to go in understanding how, when and whom to screen for breast cancer.

Elizabeth Chabner Thompson, MD, MPH, is a radiation oncologist and founder of BFFL Co (Best Friends for Life), a maker of recovery kits, surgical and recovery bras, and other products for patients undergoing mastectomy and other surgeries or treatments for cancer and other conditions.

Last Updated:9/8/2014
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Date: 17.12.2018, 01:08 / Views: 62265