Breast cancer

05 December 2008

High-risk women pre-empt cancer

As technological advances now allow women to find out if they are at risk of breast cancer, more women are opting for pre-emptive surgery to prevent the cancer developing.

SheKayla Love, 26, of Dallas, had the first cyst in her breast removed when she was just 14, the second when she was 19. By the time she found the third lump, she was 25 and had watched her grandmother die of breast cancer (after being diagnosed at 55) and her mother endure both chemotherapy and radiation after being diagnosed with the same disease and undergoing a full mastectomy at age 45.

Love's first two cysts had come back benign, but a mammogram revealed the third one to be ductal carcinoma in situ (DCIS), when abnormal cells appear in the lining of the breast duct. The condition can turn into cancer. She had had enough. Last year, after intensive praying and consultation with her family and doctors, Love underwent a preventive bilateral mastectomy.

"I was with my mom when she was going through all the doctor's appointments, the radiation, the chemo, just seeing her and the pain she went through and her hair falling out, the more I thought about it, I've had this going on for so long, I don't want to get to that point that I have to go through that and, not only me, but if I have children, I don't want to put them through that."

Love is a "previvor". Her odds of developing breast cancer have now plummeted by about 90%, and she joins a growing cadre of women who opt for some kind of pre-emptive strike against higher odds of breast cancer.

Many women opting for pre-emptive mastectomy
Many of these women, like Christina Applegate, test positive for the BRCA1 or BRCA2 genetic mutation which puts them at heightened risk for developing breast cancer and others (like Love) because they have a significant family history of the disease.

Applegate was diagnosed with breast cancer in one breast but opted to have both breasts removed in August. She is undergoing reconstructive surgery.

"We've been seeing it for a long time," said Dr Claudine Isaacs, medical director of the Cancer Assessment and Risk Evaluation Program at Georgetown's Lombardi Comprehensive Cancer Centre in Washington, DC. "There are studies that exist that show (a double mastectomy) is associated with a greater than 90% reduction in developing breast cancer."

In addition to having both breasts surgically removed, women intent on prevention can also choose to have their ovaries removed before menopause (which also lowers the risk of ovarian cancer) or for hormonal management taking birth control, tamoxifen or another drug to cut their risk.

Intensive screening is another option, Isaacs said. "This isn't going to prevent it but you hopefully are going to pick it up at its earliest stages," she said.

But the prevention route certainly seems to be gaining acceptance.

Technology more accepted
"I think what has recently changed is the acceptance of the technology. Genetic testing for breast cancer has been around for a while but wasn't approved by insurance companies," said Dr Ricardo Meade, a plastic and reconstructive surgeon with Baylor Medical Center in Dallas. "With molecular genetics, you are able to predict your risk for developing breast cancer, also your risk for ovarian cancer. You have unlocked your own genetic code, and you're predicting what the chances are for your future."

"This is very difficult, because the sickness hasn't even come up yet," Meade continued. "All you're seeing is that you might be programmed to potentially develop breast cancer, an 85% chance in a lifetime (in the case of a BRCA mutation). The previvor is the patient that takes action against this and tries to counter this by having the operation before the cells start acting. She is potentially avoiding chemotherapy and radiation therapy, and those are two of the hardest things that a human has to go through."

Love learned she had DCIS on 4 September 2007, and underwent surgery on 23 October. During the intervening weeks, her doctors told her the mass had already spread, although it was still localised.

"I feel I made the right decision," Love said. "If they had taken (the mass) out, they wouldn't have gotten it all." She gets a check-up every six months and will continue that until November 2009, when she will start annual check-ups.

"Women should just make sure they do the monthly exam themselves, and if you feel anything, even if you think it's nothing, let a doctor know," Love advised. – (HealthDay news, December 2008)


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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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