Should You Get Surgery to Prevent Cancer?

Women who test positive for the BRCA mutation and are at high risk of getting breast cancer sometimes choose to get a preventive double mastectomy. This elective surgery substantially lowers a woman’s likelihood of developing breast cancer. What is the BRCA mutation? Could you have it? What should you do if you test positive for it?

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In her compelling New York Times Op-Ed, actress and mother Angelina Jolie revealed a big secret: She has a BRCA1 gene mutation, which dramatically increases her risk of breast and ovarian cancer, and she chose to have a preventive double mastectomy. Women with this mutation have a 56 to 87% chance of developing breast cancer and a 15 to 40% chance of developing ovarian cancer.

There are two types of BRCA genes. BRCA1, which stands for “Breast Cancer 1” is located on chromosome 17, while BRCA2 is located on chromosome 13. Both genes, if working normally, prevent cancer by maintaining a natural mechanism that repairs the PTEN gene, which regulates cell division. If the PTEN gene (or other similar genes) breaks and isn’t repaired by a normally functioning BRCA gene, cells are prone to divide more rapidly and become cancerous. With a BRCA mutation, one loses the ability to fix the PTEN gene and has a higher risk of cancer.

Why Is Angelina Jolie’s Decision Considered Controversial?

Jolie isn’t the only celebrity to have tested positive for BRCA1 and undergo a mastectomy. Sharon Osbourne also got the surgery as a preventative measure last November. While Jolie and many women who test positive for the BRCA mutation may be justified in undergoing invasive and expensive surgery to remove their breast tissue or reproductive organs, some worry that it may compel other women to seek out unnecessary surgeries.

In fact, the number of mastectomies has increased in the last 20 years. A study from the Journal of Clinical Oncology found that the number of mastectomies have increased by over 150% from the late 1990s to the early 2000s. The reason for this isn’t very clear. Some experts suggest it may be due to advances in breast surgeries, which are now safer and less expensive and have more aesthetically pleasing results.

Some experts worry that it may cause a “rush of expensive testing, leading to panic and misinformation.” Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society (ACS), mentions his “nightmare is that a lot of women are going to go to their doctor and demand this test and not really need this test.”

In response to Jolie’s revelation, the ACS issued a statement praising her decision, but warning women that a double mastectomy isn’t the cure-all option for the BRCA mutation. After the surgeries, about 10% of the breast tissue still remains, and can still become cancerous. However, the latest research on the procedure shows that a double mastectomy can decrease the risk of breast cancer by 90% or more in those with the BRCA mutation.

Many women choose to get the operation in order to ease their fear of cancer. “I didn’t want to live under that cloud,” says Osbourne, who figured the odds were not in her favor after she tested positive for the mutation. Jolie decided to be “proactive and minimize the risk as much as [she] could.” She also says losing her mother to ovarian cancer at age 56 and her wanting to be around as long as possible for her six children helped her make the difficult decision.