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Vol 22, No. 10, October 2018   |   Issue PDF view/purchase
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Preventative mastectomy on the rise
A mastectomy may not be suitable for everyone, but it is a life-saving measure that more patients are opting for, especially individuals predisposed to breast and ovarian cancers.
By Catherine Domingo Ong

When girls reach adolescence, they are advised to do regular breast self-exams. It is a simple process where they would feel for unusual lumps and bumps of the breast, observe any discharge or fluid from the nipple, or notice pain or swelling in the armpit area or collarbone. The lumps can be sometimes benign (non-cancerous) and would go away on their own. Hormonal changes in the menstrual cycle also play a factor in the breasts’ appearance and texture. If the lumps you feel are hard and painful, it is still best to consult a doctor.

One in eight women in the U.S. is at risk of developing breast cancer, even when there is no previous family history of the illness. Women after 40 are recommended to have mammograms annually. For those carrying the mutations of the BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) genes, especially when they have relatives afflicted with breast or ovarian cancers, should get screened earlier.1

Early detection is still key. When caught promptly, mortality from breast cancer reduces from 25 to 30 percent. The procedure takes about 20 minutes and there is minimal radiation exposure. For women who are well-endowed, look for the option of a digital mammography so doctors are able to look into sections of the breast tissue in detail, which a regular breast X-ray may not reveal.2

Therapies after diagnosis

In the event that breast cancer has been diagnosed, a treatment plan is formed for each individual. It is largely dependent on what stage the breast cancer has escalated, as it ranges from stages zero to four.

Treatments available include lumpectomy (which removes the area with the cancerous cells and spares the rest of the breast), radiation therapy, hormone treatment and chemotherapy. Most recently, immunotherapy is emerging as an alternative treatment for chemotherapy as it has lesser side effects. It also aims to raise the body’s natural defences against the cancer cells. However, this form of therapy is only available in clinical trials while awaiting to be FDA approved.3

Mastectomy is the surgical procedure to remove the breast. It is often considered the last resort when it comes to treating breast cancer. Several factors affect whether the patient is a candidate for a partial or total mastectomy;

  • Age
  • General health
  • Menopause status
  • Tumour size
  • Tumour stage (how far it has spread)
  • Tumour grade (its aggressiveness)
  • Tumour's hormone receptor status
  • Whether or not lymph nodes are involved4

Opting for surgery does not necessarily equate to vanity or aesthetic purposes only. American actress, Angelina Jolie famously underwent a double mastectomy in 2013 as a preventative measure when she learned she carried BRCA1 gene, as her own mother passed away from ovarian cancer some years before.5

Her nine-week process involved three-steps: 1) A nipple delay procedure where they isolate the breast duct area and are able to save the areola; 2) Removal of the breast tissue and using expanders as fillers; and (3) reconstruction with implants. As a mother of six children, she wrote of her experience: “The decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”6

Due to the actress going public about her health decisions, the awareness for breast cancer has increased in the last few years.7 Dubbed as The Angelina Jolie Effect, a paper published in Health Education Journal, under Sage Publications, concluded that the high-profile case had generated 285 percent increase in the breast/ovarian cancer screening referrals and 80 percent increase in BRCA gene testing,8 thus spiking the increase in patients opting for preventative double mastectomy in the past decade.

Most doctors are now open to customising a treatment plan, with the patient’s perspective taken into account. It is within the patient’s prerogative to select the best therapy that would best suit their comfort level with regards to the least invasive option, would inflict little to no pain or increase their chances of remission.9

In 2018, an estimate of 627,000 women have died from breast cancer, according to the World Health Organization. This affliction also affects men, although a small percentage have only been reported as cases. It helps to be aware that several options are out there, and patients can now be more proactive in the decision making of the treatment they wish to receive.

A mastectomy may not be suitable for everyone, but it is an aggressive, life-saving measure that more patients are opting for, especially those at higher risk of breast and ovarian cancers genetically. A simple blood test can tell if you have the susceptible gene. When the results are in, and you find you are at risk, do not hesitate to take action and consult several doctors for every possible solution available. Making informed choices, despite less than favourable odds of being completely cancer-free, will empower the patient not to compromise or disrupt their quality of life as best they can.

References:

  1. Risk Factors: Genetics: https://www.breastcancer.org/risk/factors/genetics
  2. Mammography: Benefits, Risks, What You Need to Know: https://www.breastcancer.org/symptoms/testing/types/mammograms/benefits_risks
  3. Breast Cancer Treatment Options by Stage https://www.healthline.com/health/breast-cancer-treatment-options-stage
  4. Types of Mastectomy to Treat Breast Cancer https://www.webmd.com/breast-cancer/mastectomy
  5. “Angelina Jolie Undergoes Double Mastectomy” https://edition.cnn.com/2013/05/14/showbiz/angelina-jolie-double-mastectomy/index.html
  6. “My Medical Choice” by Angelina Jolie https://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html
  7. “Angelina Jolie's double mastectomy improved public awareness of breast cancer, according to new report” https://www.independent.co.uk/news/people/angelina-jolies-double-mastectomy-improved-public-awareness-of-breast-cancer-according-to-new-report-a6672361.html
  8. Gianmarco Troianoa, Nicola Nante and Mauro Cozzolino, “The Angelina Jolie effect – Impact on breast and ovarian cancer prevention A systematic review of effects after the public announcement in May 2013”, Health Education Journal, Vol. 76, Issue 6 (2017) 707-715.
  9. Šarunas Narbutas, Kristina York, Barry D. Stein, Kara Magsanoc-Alikpala, Yoshiyuki Majima, Zoltan Kalo, Timea Almasi, and Andras Inotai, “Overview on Patient Centricity in Cancer Care”, Frontier in Pharmacology, Vol. 2017, Issue 8 (2017) p. 698.

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