Carroll County Times
Carroll County

Double mastectomies on the rise before and after diagnosis

In recent years, more and more women faced with a breast cancer diagnosis, or even just the high risk of developing breast cancer, have opted for the surgical removal of both breasts, according to Dr. Del Corral, a plastic reconstructive surgeon with the Carroll Health Group in Westminster and Eldersburg.
"As plastic surgeons, we have really seen an increase in the last 10 years in bilateral mastectomies, for several reasons, one of which is better and earlier testing," Corral said. "Also, as reconstructive techniques have gotten so much better, more women are less concerned about getting the bilateral mastectomy."
Corral specializes in microsurgery, where tissues from one part of the body, such as abdominal skin and fat, are surgically transplanted to create living, reconstructed breasts, which he said are often a better option than implants for women who have had radiation therapy.
Although it is still relatively rare, Corral said there are also some women undergoing bilateral mastectomies before ever receiving a diagnosis, based on genetic testing that predicts a high risk of developing breast cancer.
"A bilateral mastectomy removes up to 95 percent of the risk of developing breast cancer so it's a very attractive option for many women," Corral said.
Genetic testing, along with a family history of breast cancer, was at the heart of the decision by actress Angelina Jolie, announced in May, to undergo a preemptive bilateral mastectomy, according to Dr. Kala Visvanathan, director of Clinical Cancer Genetics and Prevention Service at Johns Hopkins Kimmel Comprehensive Cancer Center.
"Based on what she has told us, Jolie has a genetic, inherited mutation that put her at high risk for developing breast and ovarian cancer," Visvanathan said.
There are two genes called BRCA1 and BRCA2, that according to Visvanathan, are associated with a higher risk of breast and ovarian cancer when present in a mutated form.
The genes can be thought of as long sentences, Visvanathan said, and if one of those sentences has a misspelling, the risk of developing cancer rises dramatically, between 40 and 80 percent depending on family history and personal risk factors.
In Jolie's case, Visvanathan said, a mother who died from breast cancer and a mutated BRAC1 gene combined to put her at high risk.
"Because she was at high risk, she felt, and her doctors felt that it was reasonable to do [the bilateral mastectomy]," Visvanathan said. "These types of preventative strategies can be an option, but are not for everyone."
The American Cancer Society expressed a note of caution following Jolie's announcement, with its Chief Medical Officer, Dr. Otis Brawley, writing a media alert that recognized the potential value of preemptive mastectomies for some women, but warned that rushing into surgery was no panacea for breast cancer.
"Experts recommend women proceed cautiously, and receive a second opinion before deciding to have this surgery. The American Cancer Society Board of Directors has stated that 'only very strong clinical and/or pathologic indications warrant doing this type of preventive operation,'" Brawley wrote. "Nonetheless, after careful consideration, this might be the right choice for some women."
According to Dr. Dona Hobart, medical director of the Center for Breast Health at Carroll Hospital Center, the importance of family risk factors in determining who might benefit from a preemptive mastectomy and the difficulty of performing BRCA gene testing means that even getting screened for the problematic gene may not be worth it for many women.
"The tests are indicated for women that would potentially be positive [for the mutated genes] and it's based on family and personal history," Hobart said. "There's no benefit from screening everyone and it would be crazy expensive."
Instead of wondering whether or not specific tests or even surgery might be indicated for them, Visvanathan said that it's far better for women to work with their doctor to take stock of their health and risk factors, something she said is generally a good idea regardless of whether or not someone suspects they may be at high risk for breast cancer.
"I would recommend that all women inquire and get a handle on their own family history and then I would suggest that they talk to their primary care doctor or [gynecologist] about their personal breast cancer risk," Visvanathan said. "If they have a strong family history of cancer, then I would seek out clinics that would evaluate them to see if they need genetic testing for inherited syndromes."