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Should women with genetic cancer mutation remove both breasts?

Angelina Jolie raised awareness of a type of gene testing for breast cancer last year when she had her breasts removed to reduce her risk of cancer. Jolie has a mutation in her BRCA 1 gene which dramatically increased her cancer risk. Her mother died of cancer at 56 after a 10-year battle with breast and ovarian cancer. Now a new study suggests that women who find out that they have the gene after being diagnosed with cancer may benefit from having both breasts removed.

In most people, the genes BRCA1 and BRCA2 produce a protein that can prevent tumors. In some people, the protein is turned off, which increases cancer risk. These people are more likely to get cancer at younger ages and to have more aggressive forms of cancer. That’s what prompts some women, like Jolie, to make the difficult choice to remove both breasts in an effort to prevent the cancer. 

Others find out that they have the defective gene only after finding out that they have breast cancer. The recently released study found that women who learn of the defective gene after a cancer diagnosis may reduce their risk of death by nearly half if they have both breasts removed. The study involved 400 women with stage 1 and stage 2 breast cancer who came from families known to have the gene mutation and many had tested positive themselves. The women were diagnosed between 1977 and 2009.

Of the women in the study, 209 decided to remove only the breast affected by cancer, while 181 had both breasts removed. Researchers traced the cancer histories of these women. Seventy-nine women died of breast cancer during the study, and 61 of those women had only had one breast removed. Eighteen women had both breasts removed. In fact, after accounting for issues such as the size of the tumor and whether it had spread to lymph nodes, women who had both breasts removed were 48 percent less likely to die of cancer over 20 years.

Health cancer experts not involved with the study cautioned in an article removing both breasts should not be an automatic decision in these cases. The study was observational rather than a double-blind, placebo-controlled activity, and it was small, one expert said, and women who have the gene may have other treatment options.

For some women, breast cancer and the ensuing treatments can leave women unable to work. In these cases, disability benefits such as Social Security Disability may be available. 

Source: WebMD News, “Double Mastectomy and Inherited Breast Cancer,” Brenda Goodman, Feb. 11, 2014

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