Breast Amputation – a Radical Idea

It’s all in the news. A very well-known lady decided to have her breasts amputated because she carries the gene for breast and ovarian cancer. She has been quoted as saying,

“My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.”

If those statistics are true, then maybe she made a good decision.

But… can any doctor really give that precise a diagnosis based on genetic testing?

Has anyone considered the concept of epigenetics which is just a fancy new term for what Dr. Page said 50 years ago:

“You can have the genetic propensity for a disease process but it’s your lifestyle that brings it out.”

That’s true for breast cancer, heart disease, diabetes and other disease processes.

Also let’s put the breast cancer genetic screening in perspective.

The breast cancer susceptibility genes (known as BRCA1 and BRCA2) occur in only 1-2% of women, but the percentage varies by ethnic group

For women without these genes the risk of breast cancer by age 70 is 8%

For women with these genes the risk of breast cancer by age 70 is 40-70%

These mutations are associated with only 5-10% of the breast cancer cases in the USA

The other 90-95% of breast cancer relate to non-genetic factors, many of which relate to lifestyle habits that can be changes

So most of us are not a risk for having those rogue genes. But should we undergo the genetic testing to find out?

Consider these recommendations from the National Cancer Institute:

(As printed in http://abcnews.go.com/blogs/health/2013/05/14/angelina-jolies-choice-should-you-get-brca-gene-testing/)

“For women who are not of Ashkenazi Jewish descent (8-10% of these women carry the gene), the NCI recommends genetic testing if you have:

• Two first-degree relatives diagnosed with breast cancer, with one of them before age 51. First-degree relatives include your mother or sister;
• Three or more first- or second-degree relatives diagnosed with breast cancer. Second-degree relatives include your grandmother or aunt;
• A combination of first- and second-degree relatives diagnosed with breast cancer or ovarian cancer;
• A first-degree relative diagnosed with cancer in both breasts;
• A combination of first- or second-degree relatives diagnosed with ovarian cancer;
• A first- or second-degree relative diagnosed with breast and ovarian cancer;
• A male relative diagnosed with breast cancer.

For women of Ashkenazi Jewish descent, who are more likely to carry a specific BRCA2 defect passed from generation to generation, the NCI recommends genetic testing if you have:

• A first-degree relative diagnosed with breast or ovarian cancer;
• Two second-degree relatives on the same side of the family diagnosed with breast or ovarian cancer.”

These recommendations indicate that most of us will not need this gene testing which can cost around $4,000.00.

But those who do carry the BRCA gene have some difficult decisions to make. What kind of follow-up should I have? Should I have regular screening for breast cancer more frequently?

A Difficult Dilemma

Currently the medical establishment recommends that BCRA positive women undergo mammography and an MRI scan yearly.

But wait, research also indicates that BCRA positive gene carriers are more sensitive to the effects of x-rays (ionizing radiation) on inducing cancer. So medicine is beginning to think that these susceptible women should only be followed with MRI scans.

Our hearts go out to those rare people who carry the BCRA gene. May they be blessed with great information and wisdom in their choices of dealing with it.

Now let’s get back to the concept of epigenetics, the way we can take personal responsibility over the expression of our genes. All of us including those with BCRA would do well to suppress the genetic susceptibility to a disease like breast cancer by following a brilliant health living lifestyle.

More about that in Part 2!

Blessings,
Dr. Jo