Can BRCA1 carriers prevent breast cancer with a mastectomy?

Breast cancer is constantly at the forefront of public discussion – it’s the most commonly diagnosed cancer in the UK. But as news hits of celebrities, such as Angelina Jolie, having mastectomy procedures as a precaution against the disease, it raises the question: Can carriers of the ‘faulty’ gene, BRCA1, prevent breast cancer in this way?

This was due to Angelina Jolie’s announcement in the New York Times in May of this year, where she revealed her decision to undergo a preventative double mastectomy.  The decision was due to the fact that Angelina carries a ‘faulty’ gene, BRCA1, which elevates her risk of contracting breast cancer to 87%.

Mr Jian Farhadi, Consultant Plastic Surgeon at London Bridge Hospital, answers the most common questions about mastectomy:

What is the BRCA1 cancer gene and how can someone be tested for it?
The BRCA1 gene is a suppressor gene. If it mutates, it can cause hereditary breast or ovarian cancer. To test for the gene, a woman simply needs to ask for a blood test, which is then analysed. How long the results take depends on when and where you have the test.

Also see: Breast Cancer – Symptoms, causes, treatments and medical support

Can anyone be tested, or do you have to have a history of breast cancer in the family?
Any woman can have the test if you are willing to pay privately. However, to have the test on the NHS or via a private insurer you need to exhibit a strong family history of breast or ovarian cancer.  A specialist will look at which members of your family had cancer and at what age they suffered from it, to determine whether the test is suitable. Normally it is only recommended for those who have a number of family members diagnosed at a young age.

What types of mastectomy are there?
There are several different types of mastectomy. The most invasive is a radical mastectomy where the majority of the tissue and skin of the breast are removed. This is normally used for those with cancer.
A skin-sparing mastectomy preserves the skin envelope and allows for reconstruction with an implant to take place straight away whereas during a nipple-sparing mastectomy, the breast tissue is removed, but the nipple-areola area is preserved. This form of mastectomy is more suited to those without cancer as a preventative measure.

Also see: Breast Augmentations: From neck ache to sporting activities 

What other options are there for women deemed at risk?
There is surveillance, where a woman monitors her risk with yearly MRIs and mammograms, or ovary removal; this reduces the risk of developing breast cancer, or taking tamoxifen, which studies have shown reduces the risk of cancer developing. However, a double mastectomy will reduce the risk to a greater degree.

How effective is a preventative mastectomy in preventing breast cancer?
During a mastectomy, you cannot remove all breast tissue as there are no defined perimeters – it is not the same as taking away the liver or lung for example. However, you can remove up to around 90%–95% of the tissue, which eradicates the risk of cancer.  For those at a high risk it is worth it, simply for peace of mind.

Also see: Skin Cancer – What are the symptoms, what can you do to prevent it and what are the treatments?

What is the recovery time after a mastectomy?
This depends on whether you opt for reconstruction at the same time. Normally post operation, you will need three to four days in hospital and recovery at home will take approximately five to six weeks.

What type of breast construction is there available?
There are two types of reconstruction. The first involves an implant being inserted, along with a matrix to hold the implant in place. The second involves using tissue from the woman’s stomach, buttocks or inner thigh to construct the breast.

Is it available on the NHS?
Treatment is available on the NHS and there is a waiting time of around four to five months for the procedure.

Also see: Prostate Cancer – What are the symptoms, who is at risk and what treatments are available?

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