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| Angelina Jolie's double mastectomy – key questions answered | |
| (35 minutes later) | |
| Is Angelina Jolie's double mastectomy a proportionate response to her risk of developing cancer? | Is Angelina Jolie's double mastectomy a proportionate response to her risk of developing cancer? |
| Jolie's surgery is just one of the ways in which she could have responded to learning she had an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer, says Gordon Wishart, a professor of cancer surgery at Anglia Ruskin University in Cambridge, who is also a breast cancer surgeon. Women in that situation could also opt for being screened more often for breast cancer – every 12, 18 or 24 months instead of every three years – or starting breast screening earlier than usual, from 30 or 35 onwards rather than 50. | Jolie's surgery is just one of the ways in which she could have responded to learning she had an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer, says Gordon Wishart, a professor of cancer surgery at Anglia Ruskin University in Cambridge, who is also a breast cancer surgeon. Women in that situation could also opt for being screened more often for breast cancer – every 12, 18 or 24 months instead of every three years – or starting breast screening earlier than usual, from 30 or 35 onwards rather than 50. |
| The National Institute of Health and Care Excellence (Nice), which advises the NHS in England and Wales on what medical procedures are most likely to benefit patients, is also consulting on whether women at high risk of breast cancer because of their family history should be able to receive the drug tamoxifen, which is currently used to treat breast cancer, to prevent the disease developing. That approach has shown some promise in some trials, prompting Nice to consider it as a possible alternative to risk-reducing surgery. | The National Institute of Health and Care Excellence (Nice), which advises the NHS in England and Wales on what medical procedures are most likely to benefit patients, is also consulting on whether women at high risk of breast cancer because of their family history should be able to receive the drug tamoxifen, which is currently used to treat breast cancer, to prevent the disease developing. That approach has shown some promise in some trials, prompting Nice to consider it as a possible alternative to risk-reducing surgery. |
| Dr Richard Francis, head of research at the charity Breakthrough Breast Cancer, says: "For women like Angelina it's important that they are made fully aware of all the options that are available, including risk-reducing surgery and extra breast screening. Though Angelina decided that a preventative mastectomy was the right choice for her this may not be the case for another woman in a similar situation. We urge anyone who is worried about their risk of breast cancer to talk it through with their doctor." | Dr Richard Francis, head of research at the charity Breakthrough Breast Cancer, says: "For women like Angelina it's important that they are made fully aware of all the options that are available, including risk-reducing surgery and extra breast screening. Though Angelina decided that a preventative mastectomy was the right choice for her this may not be the case for another woman in a similar situation. We urge anyone who is worried about their risk of breast cancer to talk it through with their doctor." |
| In England about 18,000 women a year undergo a mastectomy while about another 39,000 have some other form of breast surgery, such as a wide excision (lumpectomy). No one knows exactly how many British women have a risk-reducing mastectomy like Jolie, though Andrew Baildam, professor of breast surgery at Barts hospital in London, estimates it to be between 1,000 and 1,200 a year. | In England about 18,000 women a year undergo a mastectomy while about another 39,000 have some other form of breast surgery, such as a wide excision (lumpectomy). No one knows exactly how many British women have a risk-reducing mastectomy like Jolie, though Andrew Baildam, professor of breast surgery at Barts hospital in London, estimates it to be between 1,000 and 1,200 a year. |
| How many women have a faulty gene that increases their risk of breast cancer? | How many women have a faulty gene that increases their risk of breast cancer? |
| Only about one in 400 women in the UK carries the faulty version of either of the two genes, BRCA1 and BRCA2, both of which significantly increase the risk of breast or ovarian cancer. But, Wishart points out: "While they are incredibly rare they are also what we call high penetrance genes – that is, if you have one of these genes there's a very high chance that it will cause problems such as breast cancer." | Only about one in 400 women in the UK carries the faulty version of either of the two genes, BRCA1 and BRCA2, both of which significantly increase the risk of breast or ovarian cancer. But, Wishart points out: "While they are incredibly rare they are also what we call high penetrance genes – that is, if you have one of these genes there's a very high chance that it will cause problems such as breast cancer." |
| Having the mutated version of either of those genes means a woman's risk of developing breast cancer can be up to 80% and as much as 50% of getting ovarian cancer. These are what are called someone's lifetime risk. | Having the mutated version of either of those genes means a woman's risk of developing breast cancer can be up to 80% and as much as 50% of getting ovarian cancer. These are what are called someone's lifetime risk. |
| However, mutated BRCA genes cause only between 3% and 5% of all the 50,000 breast cancers a year that are diagnosed in the UK, or between 1,500 and 2,500 cases. | However, mutated BRCA genes cause only between 3% and 5% of all the 50,000 breast cancers a year that are diagnosed in the UK, or between 1,500 and 2,500 cases. |
| "But there are also risks [from these mutations] of other cancers, such as pancreatic cancer in both men and women and prostate cancer in men. Men carry the genes too," adds Wishart. | "But there are also risks [from these mutations] of other cancers, such as pancreatic cancer in both men and women and prostate cancer in men. Men carry the genes too," adds Wishart. |
| If a woman's mother or father has the faulty version of either gene then she has a 50% chance of inheriting it. Although the mutated genes are closely associated with women, both sexes can carry them and their risk of passing it on to a son or daughter is equal. | If a woman's mother or father has the faulty version of either gene then she has a 50% chance of inheriting it. Although the mutated genes are closely associated with women, both sexes can carry them and their risk of passing it on to a son or daughter is equal. |
| How can you find out if you are at higher risk of breast cancer? | How can you find out if you are at higher risk of breast cancer? |
| A woman with a family history of breast or ovarian cancer should see her doctor, who may refer her to one of the NHS's 35 regional genetic testing centres around the UK. About 7,500 women a year have a genetic test there to ascertain if they are carrying either of the faulty BRCA genes. | A woman with a family history of breast or ovarian cancer should see her doctor, who may refer her to one of the NHS's 35 regional genetic testing centres around the UK. About 7,500 women a year have a genetic test there to ascertain if they are carrying either of the faulty BRCA genes. |
| "The genetic test is a blood test. If a family member has breast and/or ovarian cancer they can be tested to see if the have a mutation in BRCA1 or BRCA2 and if so, which mutation they have inherited. Once you know which mutation has been inherited in a particular family, then other family members can be screened for that specific mutation by blood tests," explains Wishart. | "The genetic test is a blood test. If a family member has breast and/or ovarian cancer they can be tested to see if the have a mutation in BRCA1 or BRCA2 and if so, which mutation they have inherited. Once you know which mutation has been inherited in a particular family, then other family members can be screened for that specific mutation by blood tests," explains Wishart. |
| "Women will have genetic counselling before being tested to make sure they understand the procedure and have considered their options if the test is negative or positive. In general testing takes about three months in the NHS. If there are no living family members who have had breast and/or ovarian cancer then it is possible to sequence the entire BRCA1 and BRCA2 genes to look for mutations and this blood test is available privately," he adds. | "Women will have genetic counselling before being tested to make sure they understand the procedure and have considered their options if the test is negative or positive. In general testing takes about three months in the NHS. If there are no living family members who have had breast and/or ovarian cancer then it is possible to sequence the entire BRCA1 and BRCA2 genes to look for mutations and this blood test is available privately," he adds. |
| Anneke Lucassen, professor of clinical genetics at Southampton University, says: "Although risks of breast cancer as high as Jolie's are unusual, knowing that you have inherited a factor that dramatically increases your chances of cancer allows such risk-reducing strategies to be taken. Whether or not to have your ovaries removed is another difficult choice women in this situation have to consider. | Anneke Lucassen, professor of clinical genetics at Southampton University, says: "Although risks of breast cancer as high as Jolie's are unusual, knowing that you have inherited a factor that dramatically increases your chances of cancer allows such risk-reducing strategies to be taken. Whether or not to have your ovaries removed is another difficult choice women in this situation have to consider. |
| "Genetic testing for BRCA1 or 2 gene faults is usually undertaken if there is a strong family history of young-onset breast or ovarian cancer in the family, which is the case for Jolie. Genetic testing has been targeted like this until recently, but as techniques improve and get cheaper, anyone will be able to have a whole range of genes tested. We are already seeing an increase in operations to reduce the risk of a condition like breast cancer due to the advancements in gene testing," Lucassen says. | "Genetic testing for BRCA1 or 2 gene faults is usually undertaken if there is a strong family history of young-onset breast or ovarian cancer in the family, which is the case for Jolie. Genetic testing has been targeted like this until recently, but as techniques improve and get cheaper, anyone will be able to have a whole range of genes tested. We are already seeing an increase in operations to reduce the risk of a condition like breast cancer due to the advancements in gene testing," Lucassen says. |
| Dr Richard Francis adds: "Thanks to great advances in research we're able to pinpoint when people like Angelina are BRCA carriers and therefore at risk. However, we do need to continue vital research into breast cancer so women at high risk have even more, potentially less-invasive, prevention options." | Dr Richard Francis adds: "Thanks to great advances in research we're able to pinpoint when people like Angelina are BRCA carriers and therefore at risk. However, we do need to continue vital research into breast cancer so women at high risk have even more, potentially less-invasive, prevention options." |