Double Mastectomy May Cut Risk in Women With Gene Defect

Women with the gene mutation that led Angelina Jolie to have a double mastectomy last year may be more likely to survive breast cancer if they have both breasts removed after tumors are found, researchers said.

Double mastectomy after a cancer diagnosis cut patients’ risk of dying by 48 percent over two decades in a study of 390 women in the U.S. and Canada, researchers said today in an article published online by the British Medical Journal.

While it’s reasonable for doctors to suggest the procedure as an initial treatment for an early-stage breast cancer patient with the BRCA mutation, the findings need to be confirmed in larger trials, researchers said. The results don’t give a full answer to the question of whether women with the mutation should remove a healthy breast if a tumor is found in the other, said Karin Michels, associate professor at Harvard Medical School.

“Statistics remain statistics,” Michels wrote in an editorial published with the study. “Breasts are, however not statistics. They are essential parts of women’s identity, sexuality and self-perception.”

A double mastectomy is an “individual and personal choice” and should be made after considering alternatives such as monitoring and the use of other medicines, Michels said. Results were limited by factors including the size of the study and researchers’ inability to randomly assign women to different treatments, she said.

Mutations in the BRCA1 and BRCA2 tumor-suppression genes leave women with about a 60 percent chance of developing breast cancer, and at higher risk of developing cancer in a second breast if the first is removed. The mutation also increases the risk of ovarian cancer.

Mammogram Study

A Canadian study published today in the same journal suggested that annual mammograms don’t prevent women ages 40 to 59 from dying from breast cancer and may result in over-diagnosis. The research was a 25-year follow-up of more than 89,000 women, divided into two groups: one got a mammogram, and the other simply an examination.

Women in the mammogram group were just as likely to die of cancer, and there was one incorrectly diagnosed cancer for every 424 women who received a mammogram, the researchers said.

“Our results support the views of some commentators that the rationale for screening by mammography should be urgently reassessed by policy makers,” wrote the research team, led by Anthony Miller, a professor emeritus at the Dalla Lana School of Public Health at the University of Toronto. An accompanying editorial by Mette Kalager, a doctor in the department of health management and health economics at the University of Oslo, echoed the sentiment.

Current Recommendations

Current recommendations by the Canadian Task Force on Preventive Health Care and the U.S. Preventive Services Task Force advise against routine mammograms for women ages 40 to 49 who aren’t at an increased risk for breast cancer due to family history or BRCA mutation. For women 50 to 74, the U.S. task force recommends mammograms every 2 years.

The American College of Radiology issued a statement prior to the study’s publication saying its data were flawed, partly because of poor mammography. That included the use of second-hand machines “which were not state of the art at the time of the trial,” according to the statement.

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