Is Angelina Jolie’s double mastectomy the best option when you have the BRCA 1 genetic defect?

This is a complex issue.

On the one hand, removing both breasts with simple mastectomies and reconstructions will probably reduce the chances of getting breast cancer in woman with this defect from somewhere between 50% and 80% to about 5%.  However, the timing of the occurrence of breast cancer may be many years down the road.  For instance, if you are 35 years old and have this defect, the chances of getting cancer by 70 may be very high, but the chances in the next 15 years are much less.  By doing frequent testing of the breasts using ultrasound or MRI there’s a high likelihood of finding the cancer when it is small, if it were to occur.  For a woman who has an MRI once a year and a breast ultrasound six months later, the chances of having invasive cancer occur and being found at a stage greater than stage I may be only 5% or 10%.   In this mix, mammography should be done every year or two.

The reason for being more cautious than usual about mammography is that it has been shown in an article in European Radiology about two years ago that woman with the BRCA 1 or 2 genetic defect may statistically get their breast cancer at an earlier age then expected based on the number of mammograms and the age at which these mammograms began compared with others with the defect who did not get early or many mammograms.

Because this is a complex subject and each individual according to the defect that she has within the BRCA 1 and 2 genes may have different outcomes, a woman with this defect should have genetic counseling by a geneticist who has experience, particularly in the defects causing breast cancer.


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