Prophylactic mastectomy
A prophylactic mastectomy is the preventive ( prophylactic ) removal ( amputation ) of one or both breasts ( mastectomy ) of a woman who is either at high genetic risk ( predisposition ) to developing breast cancer or who has been diagnosed with breast cancer in the other breast . Breast removal on both sides is considered to be the safest method of preventing breast cancer in patients with a high family risk. A recent study found that regular screening and advances in breast cancer treatment offer equivalent survival benefits.
indication
Women who have a mutation in the BRCA1 or BRCA2 genes have a 55 and 85 percent chance of developing breast cancer up to the age of 70. This corresponds to a 10 to 20 times higher probability of developing breast cancer. In such cases, one speaks of a familial cancer syndrome . Especially in the case of breast cancer occurring at a young age, this predisposition plays a significant role in the incidence of breast cancer. BRCA1 mutations are found in 80% of familial diseases. BRCA1 is a gene from the class of tumor suppressor genes . It is on chromosome 17q ; BRCA2 is on chromosome 13q . In studies on mice, however, it was shown that animals with the same mutations do not become ill without further genetic changes. This means that the mutations alone are not enough for the disease to break out.
Effectiveness of prophylactic mastectomy
Numerous studies show the benefits of prophylactic mastectomy. It is generally believed that the risk of developing breast cancer is reduced by 90 to 95 percent. The resulting survival advantage is, however, marginally better at best than the precautionary measure through careful screening. Kurian et al. Updated their investigations in 2014.
A study of a total of 139 women who had a prophylactic mastectomy and had no previous breast cancer showed that the chances of developing breast cancer after the mastectomy were practically zero for the next three years. In the 76 women who underwent the surgery, no breast cancer was found in the three-year period. In the control group of 63 women who did not undergo this procedure and preferred regular monitoring, eight women developed breast cancer during the same period. This corresponds to an annual incidence of 2.5%. A 1960 to 1993 at the Mayo Clinic study with a total of 639 women yielded the following result:
214 women had an autosomal - dominant predisposition to a mammary carcinoma. 38.7 percent of the patients' sisters developed breast cancer. Most patients who had a prophylactic mastectomy were spared this fate. Only three of them developed carcinoma in the 14-year follow-up period. Prophylactic mastectomy does not provide complete protection against breast cancer.
distribution
In England, almost 50% of patients with a mutation in BRCA1 or BRCA2 opt for a bilateral mastectomy. The rate of patients who opt for a salpingo-oophorectomy is even higher .
In Germany, this measure is used very cautiously compared to the USA or the Netherlands. In Austria, 11 percent of high-risk patients opt for the preventive removal of both breasts. After Angelina Jolie announced in May 2013 that she had decided on prophylactic mastectomy, interest in appropriate advice also grew in Germany ( Jolie effect ).
See also
Individual evidence
- ↑ a b A. W. Kurian, BM Sigal, SK Plevritis: Survival analysis of cancer risk reduction strategies for BRCA1 / 2 mutation carriers. In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology Volume 28, Number 2, January 2010, pp. 222-231, ISSN 1527-7755 . doi : 10.1200 / JCO.2009.22.7991 . PMID 19996031 . PMC 2815712 (free full text).
- ↑ a b Klijn et al.: Breast cancer and prophylactic mastectomy in women with mutations of BRCA1 or BRCA2. In: Deutsches Ärzteblatt 99, 2002, pp. A-1445 / B-1229 / C-1153
- ↑ Berliner Zeitung of October 10, 2006, Wissenschaft p. 12.
- ↑ "Early Breast Cancer: Prophylactic Mastectomy Without Survival Advantage"
- ↑ H. Meijers-Heiboer et al .: Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. In: N Engl J Med 345, 2001, pp. 159-164. PMID 11463009
- ↑ L. C: Hartmann et al.: Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer. In: N Engl J Med 340, 1999, pp. 77-84. PMID 9887158
- ↑ Meyer R, Prophylactic Mastectomy: A High Price for Safety. In Deutsches Ärzteblatt 96, 1999, pp. A-808 / B-668 / C-624.
- ↑ Medical Tribune: Genetic Test for Breast Cancer: For or Against? ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. dated March 26, 2002
- ↑ BRCA1 / 2: Many gene carriers opt for mastectomy. In: Deutsches Ärzteblatt from August 10, 2009
- ↑ K. Kast et al.: Clinical management of familial breast cancer - a coverage study of the health insurance companies. ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 261 kB) In: Ärzteblatt Sachsen 2, 2006, pp. 73–76.
- ^ Prophylactic mastectomy. ( Memento of the original from October 27, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: Ärztewoche Online 18, 2004
- ↑ Preventive mastectomy in women with a genetically determined high risk of breast cancer ( memento of the original from March 5, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 248 kB)
- ↑ Genetic Breast Cancer Risk: The Jolie Effect
