Double mastectomy could save the lives of women with BRCA gene: study

Angelina Jolie authored an op-ed for Tuesday’s May 14, 2013 New York Times where she writes that in April she finished three months of surgical procedures to remove both breasts as a preventive measure.
Angelina Jolie authored an op-ed for Tuesday’s May 14, 2013 New York Times where she writes that in April she finished three months of surgical procedures to remove both breasts as a preventive measure. (AP Photo/Carlo Allegri, File)

TORONTO – Last May, Angelina Jolie told the world she had a double mastectomy after she tested positive for carrying the BRCA gene mutation.

The BRCA gene made her more vulnerable to breast cancer than most women and while she didn’t have the disease, her surgery was a preventative move. A new Canadian study is now suggesting that for women with breast cancer and the BRCA mutation, a double mastectomy could cut the risk of dying from their sickness in half.

“Hopefully with this research, we can start to think about changing our ideas about what surgical treatment a woman should have. We need to think about treating their first breast cancer but also preventing that second breast cancer,” lead researcher Dr. Kelly Metcalfe told Global News.

Metcalfe is a scientist at Women’s College Hospital and professor at the University of Toronto. She’s been studying the BRCA 1 and 2 genes for nearly two decades.

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READ MORE: Breast cancer and genetics: Angelina Jolie’s double mastectomy

This time, her research looked at the survival rates of 390 North American women with BRCA-related breast cancers.

The gene is a rarity but if women have it, it can increase the odds of breast cancer by five times. In Canada, about one in 250 women carry the BRCA1 or BRCA2 mutation that puts them at an 80 per cent risk of breast cancer.

Women with breast cancer, in general, tend to have a lumpectomy and radiation to fight their disease. But for patients with the BRCA gene, a second cancer resurfaces roughly five years later. In a matter of 15 years, about 35 per cent of these women encounter a second breast cancer in their opposite breast.

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In Metcalfe’s study, the women had either a single or double mastectomy to treat their breast cancer.

Results showed that women who had a double mastectomy had a 48 per cent greater likelihood of surviving cancer compared to their counterparts who had a single mastectomy.

And for women with a single mastectomy, when their new breast cancer developed in the opposite breast, the risk of dying doubled.

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Twenty years later, 88 per cent of women with the double mastectomy had survived, but only 66 per cent of women with the single mastectomy did.

The research suggests that treatment for breast cancer isn’t necessarily one-size-fits-all. Women who have breast cancer but don’t have the BRCA mutation don’t fare better with more surgery.

“It doesn’t seem like more surgery for the average woman translates into a greater survival benefit but what we found here is that that’s not true for women with the BRCA mutation,” Metcalfe said.

“It all speaks to the whole notion of personalized medicine and not every treatment is the same for every woman, even if they all have breast cancer.”

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Up next, Metcalfe is looking into how her findings shape patients’ decision to get a lumpectomy, single or double mastectomy.

Right now, only about 30 per cent of women with the BRCA mutation elect to have a double mastectomy. Most women tend to go with the least amount of surgery possible, but Metcalfe is noticing an uptake in mastectomies to halt any opportunities for new breast cancers to form.

READ MORE: Breast cancer and genetics: Angelina Jolie’s double mastectomy

There are two types of BRCA – or breast cancer susceptibility gene. They’re called BRCA1 and BRCA2. They’re meant to stabilize the cell’s DNA and prevent uncontrollable cell growth but if they mutate, the BRCA genes can lead to breast cancer or ovarian cancer.

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About five to 10 per cent of women with breast cancer have the BRCA mutation.

Metcalfe’s full study was published Tuesday night in the British Medical Journal.

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