Breast cancer can be hereditary, i.e., it runs in the family. Such cancers can be due to mutation in breast cancer genes (BRCA genes). The mutation in BRCA genes leads to approximately 70% increased lifetime risk of breast cancer, a 40% increased propensity of ovarian cancers, and a minor increase in chances of some other cancers. BRCA genes are conventionally tumour suppressor genes. These genes prevent cancer development by repairing DNA breaks or damage during the lifetime.
The breast cancer genes (BRCA gene) family has two genetic variants:
Mutation in these genetic components makes the person (predominantly female) prone to developing breast, ovarian, and other cancers. Therefore, the individual's family history of having breast cancer, either in the mother/sister or in any other 1st degree relatives, can be a diagnostic measure for detecting and avoiding such disease.
In a similar case, A 40-year-old woman recently reached out to Dr Mandeep (Chief Mentor & Clinical Lead, Art of Healing Cancer, www.artofhealingcancer.com) and his team. The patient is a Breast cancer Survivor and got treated for breast cancer in her early 30s. At that time, she undertook surgery, chemotherapy and radiation as the standard of care. The surgery performed during that time was a partial removal of the breast affected by cancer called Partial Mastectomy with the reconstruction of the breast. Unfortunately, two years ago, she further developed a lump in her left breast which turned out to be post-radiation fibroma but added to the high fear of cancer recurrence.
Her close family members, including her mother, had also suffered through this same dreaded cancer disease; hence, she was apprehensive about cancer coming back into her life all the time. However, upon further genomic analysis, she was proved to be a carrier of BRCA1 gene mutation.
Since the patient's family history showed consistent cases, this analysis was vital. A BRCA 1 mutation implied the following in her case:
- DNA repair mechanism that protects or fixes any damage to the DNA is faulty.
- Increased tendency for DNA to get mutated will lead to cancer formation.
- Developing breast cancer at a young age.
- Very high probability of relapse in the same or opposite breast post-surgery.
- Increased chances of ovarian cancer in future.
Along with the risk mentioned above and a constant fear of getting into the cancer cycle again, the patient decided to follow Angelina Jolie's example to get both her breasts removed.
The treating team led by Dr Mandeep Singh Malhotra (Chief Mentor and Clinical Lead of Art of healing cancer, www.artofhealingcancer.com) performed a Prophylactic Mastectomy Surgery at CK Birla Hospital, New Delhi, as a possible solution to this looms fear and a high probability of cancer recurrence.
Such surgery involves the removal of both breasts, milk ducts and breast fat with the preservation of overlying skin and nipples. The defect is reconstructed either with implants or with autologous flaps.
The reason for choosing this procedure was:
- Decreased risk of death due to cancer in BRCA-positive females by around 90%.
- Recommended around the age of 40 when lactation is over and ptosis(sag) in the breast starts appearing.
"Prophylactic Mastectomy has been proven saviour in many patients with hereditary BRCA mutations, and the increasing data towards its success in saving lives is heart-warming," said Dr Mandeep Singh Malhotra.