The removal of breasts and ovaries to prevent cancer

01:00 Wed 02nd Oct 2002 |

Wee Kaz posted a concerned question recently: "I've just heard on the radio that doctors have suggested that in order to get rid of breast and ovarian cancer us woman should consider having them removed if there is a history in your family!! Bet it was a male doctor, would he get his bits removed!"

Well, Wee Kaz, you heard more or less correctly. This is newly-published research that doesn't affect every woman - but does affect as many as one woman in 800. Research funded by Cancer Research UK suggests that the 30,000 or so women in the UK who carry a specific mutation on the BRCA1 gene should consider the surgery.

Am I at risk of this 'mutant gene'

Look at your family history. If blood relatives - your mother, grandmothers, sisters - have suffered breast or ovarian cancer, then yes the risk is greater. You are offered an annual mammography (the NHS invites all women in the UK between the ages of 50 and 64 for a mammogram every three years).

Despite the understandable concerns many women feel about the test (and less 50 percent of women from high-risk families elect to have screening) it is the first and most straightforward method of preventing breast or ovarian cancer.

Are there any alternatives to screening

There are certain drugs on the market but they don't work well on the BRCA1 mutation. The third possibility for women who test positive for the BRCA1 mutation is... surgery to remove the breasts and ovaries. This means either breast conservation surgery or mastectomy (removal of the breast). Both have been shown to be effective treatments for breast cancer.

That seems such a radical move.

According to the researchers, the risk of developing breast cancer in women who have the BRCA1 mutation is extremely high: between 50-85 percent. The risk of developing ovarian cancer is between 15-60 percent. And though screening sounds on the face of it to be the easier option, it carries certain serious risks. There are dangers involved in screening more often than once a year - but cancers can take a fatal hold in that time. Hence the doctors' decision to publicise the surgery option.

What is the BRCA1 gene anyway

It regulates the growth of cells and repairs DNA. All well and good. But when defective, it has been linked not only to inherited breast cancer but also to an increased risk of cancer of the womb, cervix, pancreas and colon.

This isn't the only form of breast cancer

'Breast awareness': vital for all women
There are some chilling statistics, as is so often the case when it comes to cancer. As many as 95 percent of all breast cancer cases are not related to the mutant genes. As many as 38,000 women every year develop breast cancer, accounting for a quarter of all cancer cases for women in the UK. The lifetime risk for breast cancer in women is one in nine.

For the cancers that don't develop from the mutant gene, alternatives to surgery (or complementary treatments) include radiotherapy, chemotherapy, hormone therapy and biological therapy.

What else should I do

Be 'breast aware' - and this advice is for all women, not just those who suspect they may be at risk of the mutant gene. The Cancer Research UK website lists the things that all women should be on the look out for:

  • changes in the outline or shape of the breast
  • puckering or dimpling of the skin
  • discomfort or pain in one breast, especially if it's new and persists
  • lumps or bumpy areas in the breast or armpit
  • nipple discharge that is not milky
  • bleeding or sore areas that do not heal
  • changes in the nipple position or rashes.

While breasts change in size and shape during the menstrual cycle, it's important to get to know what your breasts feel like and tell your doctor without delay if you notice anything different.

It may be harmless, but it may also be an early indication of the onset of cancer, and the quicker it is spotted, the better.

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