Surgical Management of BRCA Mutation Positive Patients: What are the Different Options Patients Have

The BRCA gene mutation is actually quite rare affecting only about one in 1,000 people. Only about five to ten percent of breast cancer patients developed this cancer because of this gene mutation. Only about ten to fifteen ovarian cancer patients developed this cancer because of this gene mutation. BRCA gene mutation testing is not routine. Only those who have a strong family history of breast or ovarian cancer, a personal history of breast or ovarian cancer, or a family member with a BRCA mutation will be tested. This gene mutation is tested through a blood test. Those who are found to have this gene mutation should be aware of all of their options, including surgical management of BRCA mutation positive patients.

Prophylactic Mastectomy

This surgery involves one or both breasts being removed in an attempt to reduce the patient’s chance of developing breast cancer. High-risk women who have a prophylactic hysterectomy reduce their risk of breast cancer by 90 percent, according to the National Cancer Institute. Reconstructive surgery can be done at the same time for most patients to give them back their breasts.

Immediately following the surgery, women are at risk for infection or bleeding, delayed wound healing, fluid collecting under the scar, and the formation of scar tissue. Long-term risks include this surgery being irreversible and permanent, no longer being able to breastfeed, still having the chance to develop breast cancer, significant loss of sensation in breast, depression or anxiety about body image.

Prophylactic Oophorectomy

During this surgery, one or both ovaries will be removed. Removing the ovaries will significantly reduce how much progesterone and estrogen are in the body. This does have side effects, such as excess hair growth, but it can also slow, or sometimes even stop, the types of breast cancers that require these two hormones to grow. During this surgery, most BRCA mutation patients will also have their fallopian tubes removed because they also have a higher risk of this type of cancer.

On average, this surgery will reduce the risk of a BRCA patient developing ovarian cancer by at least 90 percent. The risk of breast cancer in premenopausal woman is reduced by about 50 percent.

As with all surgeries there are risks. When the ovaries are removed the long-term risks are mostly associated with the hormone loss. These include osteoporosis (thinning bones), increased risk of heart disease, menopause symptoms, and women also have a small risk of still getting ovarian cancer, and their risk of breast cancer is reduced with this surgery, but not eliminated.

Hysterectomy with Prophylactic Oophorectomy

A hysterectomy is a surgery in which a woman’s uterus is removed. The cervix is also commonly removed during this surgery. When a hysterectomy is combined with an oophorectomy, the ovaries, and most often the fallopian tubes, will also be removed. This is by far the most invasive and extreme option for surgical management of BRCA mutation positive patients, as most woman will have all of their female reproductive organs removed during this surgery .

This surgery is a major surgery, but overall, rather low-risk. The majority of patients will experience no serious complications and will heal well. A small amount of patients, however, may experience urinary incontinence, fistula formation, vaginal prolapse, or chronic pain. When both ovaries are removed, women will begin menopause.

Resources

Mayo Clinic. (2008). BRCA Gene Test for Breast Cancer. Retrieved on July 15, 2010 from the Mayo Clinic: https://www.mayoclinic.com/health/brca-gene-test/MY00322

Breast Cancer Organization. (2008). Prophylactic Mastectomy. Retrieved on July 15, 2010 from the Breast Cancer Organization: https://www.breastcancer.org/treatment/surgery/prophylactic_mast.jsp

Mayo Clinic. (2009). Prophylactic Oophorectomy: Preventing Cancer by Surgically Removing Your Ovaries. Retrieved on July 15, 2010 from the Mayo Clinic: https://www.mayoclinic.com/health/breast-cancer/WO00095

WebMD. (2010). Hysterectomy. Retrieved on July 15, 2010 from WebMD: https://women.webmd.com/guide/hysterectomy

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Operation Suite: adamci – sxc.hu