Why we should rethink surgery in breast cancer

Wednesday January 24 2018

Aga Khan University Hospital nursing officer

Aga Khan University Hospital nursing officer explains how a mammography machine is used for scanning breast cancer. FILE PHOTO | NATION 

By ELIZABETH MERAB
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Young women with the breast cancer gene have the same survival rates as those without it, researchers have said.

In a study published in the Lancet Oncology, the researchers noted that women under the age of 40 with breast cancer have the same chance of survival whether or not they have been diagnosed with a faulty genes (BRCA).

Some women — including high-profile figures such American actress and humanitarian Angelina Jolie — have previously decided to take preventative measures, such as preemptive surgical removal of one or both of their breasts, partially or completely (mastectomy), when they discovered they had the gene mutation.

“The study showed no significant difference in overall survival or distant disease-free survival between patients carrying a BRCA1 or BRCA2 mutation and patients without these mutations after a diagnosis of breast cancer,” noted findings of the eight-year study.

Repairing DNA

Previously, it had been feared that those with the genetic fault were at greater risk of developing more aggressive forms of the disease.

A woman’s lifetime risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful alteration (mutation) in BRCA1 or BRCA2.

BRCA1 and BRCA2 are human genes that produce tumour suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material.

When either of these genes is mutated or altered, such that its protein product either is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

In this regard, people with a BRCA gene mutation are more likely to develop breast cancer, and more likely to develop cancer at a younger age.

Faulty BRCA1 or BRCA2 genes are inherited and these mutations place women at a greater risk of breast and some ovarian cancers. Studies suggest that hereditary mutations are responsible for up to five per cent of breast cancer patients.

Chemotherapy

The study by the University of Southampton involved 2,733 British women aged between 18 and 40 years and from 127 hospitals, who had been diagnosed with the condition.

The patients, 12 per cent of whom were found to have faulty genes, were followed up for an average of just over eight years.

Commenting on the findings, Prof Diana Eccles, one of the authors of the study, said: “Women diagnosed with early breast cancer who carry a BRCA mutation are often offered double mastectomies soon after their diagnosis or chemotherapy. However, our findings suggest that this surgery does not have to be immediately undertaken along with the other treatment.”

Scientists believe the results could help women and doctors make more informed decisions about their treatment in the future.

The authors, however, noted that the findings do not apply to older women with a breast cancer mutation, as they were not involved in the study and that more research would be needed in this area.