The surgery has side-effects like pain, tenderness in the breast, infection and seroma or the leaking of clear bodily fluids. Complications are also seen in patients who opt for reconstructive surgery. Many women may experience depression, anxiety and struggle with body image issues following the surgery. Is it the only option? When Angelina Jolie did it, it created quite a flutter. Imagine that: the ultimate Hollywood A-lister who regularly tops the list of most beautiful women in the world actually got rid of the very part of her anatomy that in a way defined her sexuality! A decision she arrived at in the aftermath of a genetic test, Jolie’s move to obliterate any chance for breast cancer might have been sensational. Her mother’s passing at 56 owing to breast cancer is indeed true, and that her genetic tests showed Jolie that she was vulnerable to cancer herself is also true, but it is not the only way out. While preventative surgery can lower the odds to below 5%, surgery isn’t the only option. For starters, there is close quartered monitoring which can help determine any proclivity towards cancer and nip it in the bud. This is usually more economically viable for families that do not have the juice to afford high-priced genetic testing followed by surgery, which isn’t easily affordable, either. A preventative double mastectomy is just one of the options to prevent the onset of cancer. It does reduce the risk of breast cancer by 80-90%. But it is not 100% foolproof. Explains Dr Priya, “A total mastectomy is primarily opted for when one is detected to have breast cancer that impedes the benefits of a breast-conserving one. This would be the choice that could raise the costs compared to a conventional mastectomy where the option of any reconstructive surgery for a psychological or cosmetic benefit is done at a later stage. This is done after ruling out any risk of residual disease and after any adjuvant therapy such as chemotherapy or radiation.” Defeating cancer is an uphill task, so if a patient can benefit from testing or surgery, why not? The answer lies in the fact that the cost of testing for the BRCA1 gene is very high and puts it out of reach for the common man. “The test costs about ` 40,000 in India. If a patient undergoes double mastectomy along with reconstruction, then the cost
goes up to around ` 4-5 lakhs,” says Dr Venkat. The costs are pretty high abroad as well where the cost of testing alone is around USD 3000. Also a preventative double mastectomy does not cut the risk of other cancers like ovarian which are caused by the same set of genes that cause breast cancer. Coming to the crux of the issue, does the presence of a faulty gene indicate the need for a mastectomy to prevent cancer? Dr. Raghuram says, “There are several options a woman can consider. Yes, a double mastectomy significantly reduces the risk of developing breast cancer by well over 95 per cent. But it does not however completely eliminate the risk. Some women who carry an altered gene are also at a higher risk of developing ovarian cancer. Having the ovaries and fallopian tubes removed by surgery before the natural menopause has been shown to reduce the risk of both ovarian and breast cancer.” There are other options he lists out, besides regular check-ups such as “Tamoxifen, a recently approved drug used to treat hormone receptor positive breast cancers. Five years of tamoxifen helps reduce breast cancers occurring due to the faulty BRCA2 gene by almost half. However, this modality has not gained widespread use because of its side effects such as thrombo embolisms and small risk of endometrial cancer. If Tamoxifen is used, it is usually recommended in younger women as these potential side effects are more often seen in older women and hence avoided in women over 45.” Even among the medical fraternity, there is a clear dichotomy of opinions. On the one hand are doctors who believe that removal of the breast is inappropriate until such time that cancer develops, and on the other hand, there are doctors who don’t perceive it as an inappropriate choice at all. Some of the more useful alternatives include periodic mammograms and close surveillance to nip any possible development towards carcinoma in the bud. This can also be augmented by self-examinations. Some medications also assist in reducing the risk of breast cancer – although these are best taken only under the supervision and direction of a physician. These options are best for the masses in alternation to preventative mastectomy. The decision to go under the knife as a prophylactic measure should be arrived at only after sound justification and reasoning, and only after making an informed decision with a complete stock of all the risks and benefits.
HAWK EYE
taking on a surgical prevention,” adds Dr Priya Selvaraj.
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