Breast cancer: Making the tough decisions

Drs. Techksell Washington & Karen Powers

Drs. Techksell Washington & Karen Powers

The BRCA1 and 2 gene mutations that predispose women to aggressive breast cancer got a lot of attention this year when actress Angelina Jolie shared her preventive double mastectomy with the world.

In honor of Breast Cancer Awareness Month, and as breast specialists at the University of Texas Medical Branch, we think it’s a good time to take another look at some of the details surrounding genetic testing, treatment options and reconstruction decisions.

Jolie’s public sharing of her personal story surely resonated with many women who think they may be at risk. If you were one of them, we advise speaking with your primary care physician about genetic testing.

UTMB’s Breast Health and Imaging Center has a high-risk clinic with genetic counselors who can guide patients through screening and potential genetic testing for the BRCA1 and 2 mutations. Women with those mutations have a more than 80 percent chance of developing breast cancer and a 40 percent chance of developing ovarian cancer during their lifetimes.

The mutations represent 10 to 15 percent of all breast cancer, which is a relatively tiny percentage of all women. Women who don’t have the genetic predisposition for breast cancer shouldn’t view Jolie’s decision as an example to follow.

For those who do have a mutation, however, the very knowledge of their genetic status offers a chance to lengthen their lives significantly.

It often takes years for high-risk women to make the decision to have a double mastectomy. However, if you find out you are one of these women, there are individualized courses of action.

Some women choose not to have preventive mastectomies and opt for increased screening with annual breast MRIs, staggered with mammograms at least every six months.

For women who do choose mastectomy, there are several decisions to make, including whether to preserve their nipples. A relatively new surgical procedure, nipple preservation, is increasingly being performed nationwide, although not all women are appropriate candidates.

Plastic surgeons can also help patients decide whether implant or tissue-based reconstruction is best. Tissue often comes from fat in the lower abdomen but in some cases can be transferred from the buttocks or back. The procedures for transferring tissue are longer and more involved but often create a more natural outcome since the reconstructed breast is made of the patient’s own tissue.

As far as implants go, we typically recommend silicone implants over saline because they look and feel more like breast tissue.

Because all of the breast tissue is removed in a mastectomy, there is no breast tissue over the implant like there is in cosmetic augmentation.

Therefore, the ripples of a saline implant can be more visible.

If you’re a woman at risk for breast cancer, arm yourself with knowledge and work with your health care provider to determine an individual course of action.

Some preventive treatments may seem daunting. But it’s so important to begin the conversation with your practitioner. Now is the perfect time to make the appointment. We encourage you to take that step.

If you’d like to learn more about breast reconstruction after mastectomy, join us at noon Wednesday. We’ll offer a light lunch and discussion about reconstruction options. It’s free but reservations are required. Call 832-505-1020.

Dr. Techksell McKnight Washington is a medical oncologist at the University of Texas Medical Branch. She heads up the preventive oncology program for women at high risk for breast cancer. Dr. Karen Powers is an assistant professor of plastic surgery at UTMB specializing in breast reconstruction.

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