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Is the drastic step a sensible precaution?
Breast cancer is the most common cancer in women, affecting around 70,000 people each year. In about ten percent of cases, the genetic predisposition plays a role in the genesis, but there is a special test that can detect corresponding changes in the genome. A positive result means a significantly increased risk and presents the woman concerned with the decision about a possible operation. The most famous example is Hollywood star Angelina Jolie, who had both breasts removed and her ovaries removed due to her family history. But does such a rigorous step make sense? In an interview with the "dpa" news agency, experts provide information about the possibilities and limits of this approach.
Less than ten percent of cases are based on high-risk genes
"Can breast cancer be inherited?" In fact, a small proportion of patients have a genetic predisposition to the disease. But there is a special test that can determine changes in the genetic material based on a blood sample. A positive result indicates a significantly increased risk and raises many concerns and uncertainties for the women concerned. "Should I have my breasts removed as a precaution, or not?" This question can only be answered by the woman herself and usually requires an intensive decision-making process.
Radical breast cancer screening: amputation of both breasts. Image: Eskymaks - fotolia
The breast cancer genetic test is performed using a blood test and is only recommended for women who are actually at risk for breast cancer. Because this only applies to a small proportion. Accordingly, less than ten percent of the approximately 70,000 women who develop breast cancer each year are based on high-risk genes, according to Kristin Bosse from the Center for Family Breast and Ovarian Cancer at the University Hospital in Tübingen.
German consortium for familial breast and ovarian cancer sets nine criteria
In order to be able to define whether a person has a genetic predisposition, the German consortium for familial breast and ovarian cancer has defined nine criteria, at least one of which must be fulfilled. Accordingly, there is an increased risk e.g. if three women in the family - regardless of age - have breast cancer or two women have ovarian cancer. The same applies if a woman gets breast cancer before her 36th birthday or if a woman in the family suffers from breast and ovarian cancer. "You need such evidence," explains Prof. Christof Sohn from the Heidelberg University Women's Clinic. If these were available, the diagnosis could be started.
Modifying one of the two BRCA genes means significantly increased risk
The test particularly interested in the genes "BRCA1" and "BRCA2", which were examined for possible changes, explains Christian Albring from the professional association of gynecologists. The term "BRCA" stands for "BReast Cancer", which comes from English and means breast cancer. If the test is positive, however, it cannot be determined with certainty whether and when the disease will break out. However, a change in one of the two BRCA genes means a significantly increased risk of developing breast and / or ovarian cancer.
According to this, an altered BRCA1 gene would cause an average of between 60 and 80 out of 100 women to develop breast cancer during their lifetime. If the BRCA2 gene were changed, the risk of ovarian cancer would be 10 to 20 percent and that of breast cancer 45 to 80 percent, Albring added. "Without these changes, the risk of ovarian cancer is 1.5 percent and the risk of breast cancer is ten percent."
As Kristin Bosse reports, many women would now use the test to get clarity about their health situation. Fear of a positive result would rarely stand in the way, because “In the medium and long term, not knowing cannot be endured better than knowing and the associated opportunities to act.” Cindy Eibisch, who works with the Cancer Center Dresden for the psycho-oncological service, also confirms the high willingness of the patients to be tested in order to know their personal cancer risk.
If the test is positive, a close screening program follows
If there is a positive result, an intensified early detection program follows for the risk patients, which, depending on the age, different procedures such as Tactile examinations, ultrasound, mammography or an endoscopy. "You can't prevent cancer with it, but you can discover it early," says Prof. Christof Sohn. According to Kristin Bosse, the tests should be carried out in one of the 15 university centers of the German consortium for familial breast and ovarian cancer. Because here the women concerned could also take preventive measures such as advice on a decrease in breasts.
However, this is a process that "must happen in one", continues Prof. Sohn. Because before such a step, there are many questions and concerns that, according to Cindy Eibisch, should first be clarified. Thoughts such as "How is the result?" Or "What does my partner say about it?" Would accordingly be discussed in advance with employees from psycho-oncology. Sometimes there are also meetings with women who have already had the procedure, explains Eibisch.
According to Kristin Bosse, an increase in the number of interventions can be observed especially with the precautionary removal of the mammary gland. One of the reasons for this is that this is the only way to reduce the risk of cancer as much as possible, and the cosmetic results are getting better and better. Despite the medical advances, women should be aware of the change, according to the expert, because "you always wake up with a reconstructed breast."
Preventive removal of the ovaries usually only takes place from the age of 40
Preventive removal of the ovaries, on the other hand, hardly plays a role in younger women and is normally only recommended after the age of 40. From then on, the risk increases significantly, whereas under 40, only about three to four percent of women with an altered BRCA1 gene would develop ovarian cancer. According to Albring, if the ovaries are removed, a “menopause situation” arises, since estrogens and progestogens are no longer produced. In order to prevent menopause symptoms and osteoporosis, hormone replacement therapy can help some women. "It is more difficult for those who have breast cancer," explains Albring, because hormones should not be given here easily. Typical complaints such as In these cases, sleep disorders could be treated, for example, by non-hormonal drugs. (No)