Friday, September 27, 2013
It’s not the only option for women at increased breast cancer risk
Last May, Oscar-winning actress Angelina Jolie announced that she had a double mastectomy, even though she hadn’t been diagnosed with cancer.
Jolie chose to undergo the procedure because genetic testing revealed she has a mutation of the BRCA1 gene. Women with a BRCA1 or BRCA2 gene mutation have up to an 87 percent increased risk of breast cancer. After a double mastectomy, that risk drops to 10 percent or less.
Many women wonder what they’d do if they were in Jolie’s shoes. Does a BRCA1 or BRCA2 mutation mean you have to have a double mastectomy?
“These mutations increase the risk of breast cancer significantly, but only 5 to 10 percent of breast cancer cases are due to a mutation in the BRCA1 or BRCA2 genes,” says Michael Simon, M.D., MPH, director of the Cancer Genetic Counseling Service at the Karmanos Cancer Center and professor of Oncology at Wayne State University School of Medicine. “Patients have options. You might opt for more frequent breast cancer screenings, take medication to lower your risk, or choose to have a preventive double mastectomy.”
A woman who has a BRCA1 or BRCA2 gene mutation but doesn’t have breast cancer or a strong family history of the disease may want to monitor her breast health by alternating a mammogram and breast MRI every six months. Increased screening doesn’t prevent cancer, but it can help diagnose the disease at an earlier, more curable stage. Other women with a mutation might take preventive medications like Tamoxifen or Raloxifene, which can lower breast cancer risk by as much as 50 percent.
“In terms of cancer prevention, a woman with a gene mutation who has seen her mother, sisters or aunts battle breast cancer might want to decrease her risk by having a double mastectomy,” Dr. Simon says. “Karmanos has surgeons who specialize in breast surgery as well as expert plastic surgeons who offer implants or tissue-based reconstruction. However, a decision as to whether or not to undergo preventive surgery is a personal choice made by the woman.
“It’s important to remember that a gene mutation doesn’t mean you will automatically develop breast cancer. It just means you’re at increased risk. People should use that information to make informed decisions about their medical care.”
Genetic testing can establish if you have a specific gene mutation that increases your risk of cancer. An evaluation with the Cancer Genetic Counseling Service at Karmanos can help determine if genetic testing is appropriate for you. For more information about genetic counseling services at Karmanos or to schedule an appointment, call 1-800-KARMANOS or visit karmanos.org.
FACTS ABOUT BRCA1 AND BRCA2
• BRCA1 and BRCA2 stand for breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2, respectively.
• BRCA1 and BRCA2 are human genes that suppress tumors. Mutations of these genes have been linked to the development of hereditary cancers of the breast (in women and men), ovary, prostate and pancreas, as well as melanoma.
• These gene mutations put a person at increased risk for these cancers, but not every person with a mutation will develop cancer.
• In most cases, the BRCA1 and BRCA2 gene mutations are inherited. The mutations are more common in people of Ashkenazi Jewish (Central/Eastern European) descent.
• A simple blood test can determine if you have a gene mutation.
Source: Nancie Petrucelli, MS, CGC, senior genetic counselor/coordinator, Karmanos Cancer Genetic Counseling Service