News of Angelina Jolie’s preventative double mastectomy after learning she had a gene that raised her risk of breast cancer to 87% and ovarian cancer to 50% has everyone asking, “did she have to take such an extreme step”?
“Yes,” says onco-surgeon Dr Sameer Kaul at Apollo Hospitals, “I would recommend it and so should everyone else. BRCA1 or the BRCA2 genes are established and identifiable causes of breast and ovarian cancers. It is a formidable decision, but preventing death makes it worth it.”
Preventable mastectomy, which involves having both breasts surgically removed even when not diagnosed with cancer, is considered when a woman has inherited a faulty version of the BRCA1 or the BRCA2 genes.
Breast cancer is the leading cancer among women in developed countries. In India, it has overtaken cancer of the cervix as India’s number one cancer in urban women.
The preventive surgery is less invasive than mastectomy in cancer patients. “It’s a simple surgery. We remove the glandular tissue through a cut in the breast fold or the areola and replace it with fillers. You may end up with a better looking breast,” says plastic and reconstructive surgeon Dr Shahin Nooreyezden. “I think preventive mastectomy is a bit drastic, but if it makes you sleep better at night, we should give it you,” he adds. Reconstruction adds between Rs. 1 lakh and Rs. 1.5 lakh to the cancer patient’s tab.
“In India, where breast cancer is being diagnosed in women in their 30s and 40s, chemoprevention is often not a viable option,” says Kaul. He has operated on two women, ages 35 and 32, who chose to undergo preventive mastectomy, one as recently as three months ago.
But the trend is unlikely to catch on in India. Very few women inherit these faulty genes, with the mutations commonly found in women of Eastern European Jewish descent.
BRCA1 or BRCA2 genetic testing requires a blood sample and costs between Rs. 40,000 and Rs. 60,000.