A growing number of women are choosing to get their breasts removed to reduce their risk of getting breast cancer. Angelina Jolie’s decision to do this has had a huge impact on the issue, but now a new piece of research finds that the decision-making process is not quite as clear cut as it may seem from the path Jolie chose. The actress got her double prophylactic mastectomy because she carries the BRCA1 gene, which significantly increases a woman’s risk of getting breast cancer, and hikes the risk for ovarian cancer as well.
The new JAMA study looked at other genes that increase breast cancer risk, but are not as dangerous as the high-risk genes like BRCA1 and BRCA2, with the goal of assessing when women should go the same route that Jolie went. It’s an excruciatingly hard decision to make — so a study like this is extremely important. Study author Dr. Judy Garber told SurvivorNet that because the risk/benefit ratio of the prophylactic mastectomy is still unclear, determining when to get the surgery “may take consideration of other factors.”
Dr. Elizabeth Comen, a medical oncologist and advisor to SurvivorNet, said that it’s important for people undergoing genetic testing to understand the difference between absolute risks and relative risks.
“Absolute risks are quite different from relative risks,” said Dr. Comen who helps patients through these issues in her practice at the Memorial Sloan Kettering Cancer Center. “A bilateral mastectomy is a forever decision — one never gets their breasts back and there can be complications from surgery — both short-term and long-term … there are many women who would say ‘I can’t handle the emotional and potentially physical consequence of any increased risk, not worth it to me, and I’m OK with never having breasts again.'”
However, Dr. Comen also noted that because it is not yet known who will benefit from removing their breasts when it comes to these moderately risky gene mutations, “it is essential that doctors help patients understand what their individual breast cancer risks may be based on specific mutations and other factors. And perhaps most importantly, it is critical that doctors and patients explore how the emotional experience of that uncertainty informs surgical decisions.”
“More work needs to be done to help refine our advice to individuals with increased risk of cancer so that we can help them make more precise decisions,” Dr. Comen said.