TVHC provider Dr. George Linhardt answers questions about breast health, breast cancer and treatment options.More
Genetic testing for breast cancer has prompted several nationally known individuals to undergo mastectomies to reduce their chance of developing breast and ovarian cancers. BRCA (pronounced braca) testing is used to screen women who may have a very strong chance of developing these cancers. When positive, women are counseled about their risk, and advised that each year their risks increase by a certain amount, and of their ultimate lifetime risks.
There are two types of the BRCA genetic mutations, 1, and 2. Each has separate, increased risk factors for ovarian and breast cancers.
The genetic code is the instructions for the body, and can be viewed as a long twisted train track. When there is a mutation, a railroad tie is altered, broken or changed. This leads to medical issues.
The BRCA mutation occurs in only 5 percent of all breast cancers and 10 percent of ovarian cancers. However, if you have this mutation, your risk of developing breast cancer may be as high as 80 percent. If you develop breast cancer in one breast and have this mutation, you have a 4-times higher risk of developing cancer in the opposite breast. With this high risk in developing cancer and the risk for the opposite breast, women may elect to have surgery before they have a cancer diagnosis.
Genetic testing is not needed for everyone and can be very expensive. The majority of breast cancer patients do not have a positive genetic profile and are not helped by the test, or may feel that they are no longer at risk.
Who needs the test:
- Women who develop breast cancer at an early age (under 50)
- Women who has family members with breast cancer at before age 50
- Women who have several first degree relatives with a diagnosis of breast cancer
- Women of certain ethnic origins Ashkenazi Jewish descent
- Men who have breast cancer
- Women with ovarian cancer of at any
The interpretation of genetics testing is complicated, and should be done with a trained geneticist or physician to avoid confusion or inaccurate interpretation. There are implications of genetic testing. It may have an impact on one’s life, and personal emotion. These tests may or may not be covered under health insurance policies. The cost may be several thousand dollars.
When the genetics tests are positive, several breast-specific options are considered; close observation, prophylactic (preventive) surgery or chemoprevention.
If surgery is recommended, there are several options again. The mastectomy can be a complete mastectomy; the skin and the breast tissue are removed. The lymph nodes are not removed. More recently, most patients elect to have a skin sparing mastectomy with immediate reconstruction. This reconstruction typically involves the use of a prosthesis or implant to provide a breast contour. An alternative is the use of the abdominal muscle or back muscle without an implant. This is a much bigger surgery with a longer recovery time and is less frequently performed. In both approaches, the nipple is removed. With all mastectomies, there is all always the chance of breast tissue remaining, and nationally it is considered to be 97 percent complete. This dramatically reduces the chances of breast cancer, but the chance is not reduced completely.
The skin sparring nipple, sparing mastectomy is the newest approach. With this operation, the nipple remains in its natural position or moved to better position. As the nipple is breast tissue, the cancer risk is slightly higher risk over other mastectomy options. It provides the most natural appearance.
People seeking more information on line should view the websites of the American Cancer Society, the National Comprehensive Cancer Network and the National Cancer Institute. There are portals for patients and health care providers and are free of charge.
Dr. Linhardt is a general surgeon at Teton Valley Health Care with a specialty in breast surgery. He has pioneered the treatment of some breast diseases. He is available to see patients at the Driggs Health Clinic. Call (208) 354-2302 to make an appointment or visit tvhcare.org for more information.
– This column originally appeared in the Teton Valley News.More