Mitigating BRCA Breast Cancer Risk With Mastectomy, Oophorectomy

For women at risk for an inherited type of breast cancer, the decision to be tested for specific genes and make preventative decisions can be life-changing. Such is the case for actress and director Angelina Jolie- Pitt, who at age 37 underwent a prophylactic bilateral mastectomy after learning that she too carried the BRCA gene that caused cancer in her grandmother, aunt, and her mother. Her mother died at age 56.

Jolie-Pitt most recently wrote about her decision to also have her ovaries and fallopian tubes removed because the gene that can cause breast cancer also causes her to be at high-risk for ovarian cancer.¹ Removing ovaries can lessen the chances that a woman, who is at high-risk for cancer, of getting cancer, according to the Mayo Clinic.²

Another way to determine the next steps for breast cancer prevention is to consider noninvasive tests, such as magnetic resonance spectroscopy (MRS), which monitors biochemical changes in tissue and could help women at high-risk. This study, conducted by radiologists at the Centre for MR in Health, School of Health Sciences, University of Newcastle, Australia, shows that MRS is a way to detect precancerous breast cancer cells. This enables women and their doctors to decide on a wait-and-see approach, or take more immediate measures.³

Because of Jolie-Pitt's recent public announcement, more women may be calling their doctors and asking if genetic testing is right for them. For most women, unless they have a first-degree relative, such as a mother or sister with this type of cancer, they are not likely to carry the gene. That being said, there are several other types of breast cancer, such as inflammatory breast cancer, which is an aggressive form of breast cancer that can occur in women with no family history. 

In general, women have about a 12% chance of developing breast cancer during the course of their lifetime. This risk increases to 55% to 65% in women with the BRCA1 or BRCA2 gene mutation.⁴ Outside of genetic testing, women at any age who feel a lump during a routine monthly breast exam should report this to their healthcare practitioner immediately for further testing.

Aside from breast cancer, 39% of women who inherit a BRCA1 mutation, and 11% to 17% of women who inherit a harmful BRCA2 mutation may develop ovarian cancer by age 70.⁴

For women and men who are BRCA mutation carriers, it's important to seek out the advice of a genetic counselor and/or healthcare provider in order to determine if children and other family members should obtain testing as well. Each child of a parent who carries a mutation in one of these genes has a 50% chance of inheriting the mutation.⁴

While many may be quick to say that it's important for high-risk women to move forward with having their breasts and ovaries removed, we need to consider that young women that decide on an oophorectomy will experience early menopause and will no longer be able to bear children. Patients need to weigh all the options before making these decisions.

References:

• Jolie-Pitt A. (2015). Angelina Jolie Pitt: Diary of a Surgery. The New York Times: The Opinion Pages.  
• Mayo Clinic. (2014). Prophylactic oophorectomy: Preventing cancer by surgically removing your ovaries.
• Ramadan S, Arm J, Silcock J, et al. (2014). Lipid and Metabolite Deregulation in the Breast Tissue of Women Carrying BRCA1 and BRCA2 Genetic Mutations. RSNA Radiology.  
• National Cancer Institute. (2014). BRCA1 and BRCA2: Cancer Risk and Genetic Testing.