Angelina Jolie's preventive double mastectomy - your questions answered

Actress Angelina Jolie underwent a preventive double mastectomy in order to keep breast cancer at bay. The actress's mother died at the age of 52 from ovarian cancer, and she herself was found to have the mutated form of the BRCA1 gene which put her at a 80 per cent risk of developing breast cancer.

What is this procedure? Why did she need to have it? How is the genetic testing for breast cancer done? Is it available in India? We answer some such questions in this post.

What is a preventive mastectomy and why is it needed?

Also known as prophylactic or risk reducing mastectomy, it involves removing both breasts in order to reduce the chances of breast cancer in the future. A preventive mastectomy is recommended for women who are at a very high risk of suffering from the disease. The risk factor for a woman is decided by certain tests that detect the genetic mutation within certain genes. In Angelina Jolie's case, it was the BRCA1 gene.

What is the BRCA1 gene?

There are two genes that make a woman susceptible to breast cancer the BRCA1 and BRCA2 gene. The BRCA1 gene is a type of tumor suppressor gene. It is named the breast cancer, early onset gene and its main function is to repair damaged DNA. The gene is primarily found in the breast tissue and is largely responsible for breast cancer, ovarian cancer and cervical cancer in women. The mutation of this gene results in a malformation or broken DNA which then leads to the formation of a cancer.

How are these genes detected?

The BRCA gene test is an analysis of the DNA to identify any harmful mutations. These mutations are found either by a blood test or a bone marrow test and are recommended for people who are at risk of contracting a very specific type of breast cancer or ovarian cancer. Having the BRCA1 or BRCA2 gene mutation is fairly uncommon and has only about a 5 per cent chance of leading to breast cancer and 10 to 15 per cent chance of leading to ovarian cancer.** After the test genetic counseling plays an important part in the testing process.

Are these tests available in India?

There are a few hospitals and diagnostic labs in India that can help with genetic testing for this trait. The forerunner of these centers is the Tata Memorial hospital, and other centers include testing labs like NutraGene, that provide genetic testing for various ailments including cancer.

According to our expert Dr Shah, 'Genetic testing is a very sensitive issue. And the results of genetic testing can sometimes may need to be interpreted with extreme care, because any decision is going to affect the patient's life as also that of the blood relatives. Knee jerk reactions are very common in India and people tend to decide on their own. No patient should ever go for any form of genetic testing directly, on their own. It is very essential that patients and relatives discuss the same with their oncologist, and preferably get a special genetic counselling first from a qualified genetic counsellor. Not all patients need genetic testing, criteria have been laid down as to which patients and their offsprings or sisters should undergo genetic testing. And the oncologist or the genetic Counsellor will guide them whether they need to undergo genetic testing or not. So I would suggest all readers to consult their oncologist about need of genetic testing and then decide about the same.'

Does the whole breast need to be removed for prophylactic mastectomies?

Though there are many different options available in cases where women are already suffering from breast cancer, in the case of preventive or prophylactic mastectomies, either a total mastectomy (entire breast tissue, areola, nipples and associated structures, lymph nodes in the armpit and the chest muscles are spared) or a nipple sparing mastectomy(tissue within the breast is removed, but the skin, chest muscles and the nipple are kept intact) is indicated.

What are the risks involved in a mastectomy?

If the surgery is performed well there are minimal associated risks. However, there are a few things that a woman should be prepared for - bleeding, infection, pain in the armpits and chest area, swelling around the arms, formation of scar tissue, shoulder pain, numbness around the surgical site etc.

According to our expert Dr Sumeet Shah, leading surgical oncologist,'there are no side effects of the surgery as such. Swelling of the arm on the same side (due to surgery in the armpit, to remove the nodes) and cosmetic issues (psychological effects due to loss of the breast) are the only effects after mastectomy. Normally there are no hormonal changes seen, due to removal of the breasts.'

Is there any other treatment required after the surgery?

According to Dr Sumeet Shah, 'A woman may be asked to undergo either chemotherapy or radiotherapy after a mastectomy, depending on the pathological reports after removal of the cancerous tissue'. However, in cases of preventive mastectomies, no further treatments are required post surgery.

While most people decide to opt for a mastectomy after being diagnosed with breast cancer, it takes a lot of courage to get the surgery done as a preventive measure. We at Health.India.com, laud the efforts of Angelina Jolie in taking a proactive stance against the disease. In the words of the actress, now her kids can live without the worry of losing their mother.

Read more about causes, symptoms, diagnosis and treatment of breast cancer.

Statistical source: *http://www.breastcancerindia.net

** http://www.mayoclinic.com

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