Recently, actress Angelina Jolie announced that she underwent a preventive double mastectomy after learning that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast cancer and ovarian cancer. This announcement again increased the discussion in the media about the choices women have when it comes to breast cancer surgery.
Not all women need a double mastectomy if they have breast cancer in one breast. About one in 200 women in North America carries a BRCA1 or BRCA2 mutation. But among certain ethnic groups the prevalence is considerably higher. Notably, the frequency in those of Ashkenazi Jewish ancestry is one in 50. Other groups with high frequencies of mutations include women from Iceland and Poland.
For the vast majority of women, who have no BRCA gene mutation, the following surgical options are available:
-Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following: a) Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it. b) Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. The lining over the chest muscles below the cancer may also be removed. This procedure is also called a segmental mastectomy. These patients may also have some of the lymph nodes under the arm removed for biopsy. Quite often these patients require radiotherapy after surgery.
-Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. Most of the time these patients do not require radiotherapy after surgery.
-Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
If the size of the growth in the breast is relatively big (locally advanced cancer) then the patient receives chemotherapy before surgery to shrink the tumor. Treatment given before surgery is called neoadjuvant therapy.
Treatment after surgery consists of radiation therapy, chemotherapy and hormonal therapy even if the doctor removes all the cancer that can be seen at the time of the surgery. This is to kill any cancer cells that are left behind. Treatment given after the surgery, to reduce the risk of recurrence, is called adjuvant therapy. Again, not all breast cancer patients require adjuvant therapy. Your oncologist decides on this depending on the stage of the cancer, what kind of surgery you had and what is your risk of having cancer recur.
Women who opt to have their breast completely removed can have breast reconstruction done. Breast reconstruction may be done at the time of the mastectomy or at a future time.
Some of you must have heard about sentinel lymph node biopsy in cancer surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. This is biopsied. If it is negative for cancer cells then it may not be necessary to remove more lymph nodes.
This is a very simplified way to explain to you what kind of treatment options are available for women with breast cancer. In each case, your surgeon and oncologist will advise you what your options are. Because of the technology, experience and expertise of our doctors, the prognosis of breast cancer has improved a lot. So do not panic. There is plenty of help for women with breast cancer.
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