— How do you feel about mastectomy? In what situations is this operation indicated?
Mastectomy (from other Greek mastòs - breast and ek tome - remove) is a surgical operation to remove the mammary gland. The essence of the operation: removal of the mammary gland, fatty tissue that contains lymph nodes.
The main factor for selecting a method of surgical treatment of breast cancer is the stage of the tumor process and the localization of the formation itself in the breast tissue. Contraindications to performing organ-preserving surgery are:
- Location of the tumor in the central part of the mammary gland,
- Several tumors located in different parts of the organ (multicentric form),
- Edema and inflammatory (mastitis-like) forms of the process,
- Expected poor cosmetic result (small breasts).
There remains a high probability that when a safe operation is performed, areas of microcalcification deposits and microtumors may remain in the remaining breast tissue, from which a tumor will subsequently develop - a relapse. Such doubts sometimes lead women to refuse to preserve the organ.
I am willing to agree with this statement if prophylactic radiation therapy is not given to the remaining part of the breast after surgery. Of course, it is very stressful for patients to hear from a doctor that an organ cannot be saved. A feeling of the unknown, fear for the future, dramatic changes in appearance - this is only a small part of the emotions and experiences that affect our patients. But modern surgery makes it possible to preserve the mammary gland using reconstructive and plastic surgeries at different stages of treatment of this pathology.
Operation
Angelina Jolie had her mammary glands removed in one of the best clinics in the USA. Her husband Brad Pitt was next to her all the time. They did everything in secret, the paparazzi are now nervously biting their elbows, because they never managed to find out or film anything.
The actress's doctor, Dr. Karlan, once treated her mother. Therefore, she is well aware of the film star’s heredity. In the early 90s. The doctor was part of a group of specialists who found that a mutation in one gene leads to the occurrence and development of ovarian and breast cancer. Unfortunately, this mutation is inherited from a person's parents.
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Dr. Karlan argues that in the 21st century, with modern technology, it is extremely important to determine which relatives were sick with what and who died from what. This knowledge can save the lives of the next generation.
Such a bold step will allow a woman to be with her children longer. After all, she knows firsthand what it’s like to lose a loved one. Her mother and grandmother had ovarian and breast cancer. Not everyone can make such a choice, but it gave Angelina more confidence in the future.
— How often and under what conditions is this operation performed for preventive purposes?
Due to imperfect legislation in our country, there is no law that would allow expanding the indications for complete removal of an organ that is still healthy. Patients with BRCA I and BRCA II gene mutations went to European countries for preventive operations. But recently, subcutaneous mastectomy has also begun to be performed in domestic clinics. The advantage of subcutaneous mastectomy is that the surgeon can immediately perform plastic surgery without making additional incisions, without resorting to additional surgery, using the patient’s own muscle tissue. At the same time, the muscles move and their blood supply is maintained. Well, if there is not enough natural tissue to form the shape of the breast, then an implant is used.
Probability of illness
Angelina Jolie's disease was not discovered; doctors only reported an 87% probability of maternal transmission of the disease. Unfortunately, Angelina Jolie's biography is overshadowed by the death at a young age of her mother and grandmother from breast cancer. Therefore, Angelina did not wait until her cancer developed and decided to go under the knife. Let us remind you that Jolie Angelina is now the mother of six children, three of whom are natural and three are adopted. She promised them that she would never leave them. Jolie stated that she did this solely for the sake of her children.
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According to American doctors, modern technologies allow them to determine who may be sick and with what. Healthy people have an excellent chance to prevent disease. Angelina might not have gotten sick, but the odds were reduced to 9:1. All this is due to bad heredity.
— What kind of gene is BRCA1, what analysis helps to identify it and what to do if it is detected?
BRCA1 and BRCA2 are the most studied and frequently encountered highly penetrant susceptibility genes for breast cancer, while mutations in the CHEK2, ATM, BRIP1 and PALB2 genes cause an average risk of this malignant pathology.
BRCA-1 is a cytosomal dominant gene located on chromosome 17. Its expression increases the overall risk of developing breast cancer to 85%, with 33–50% of cases under the age of 50 years and 56–87% before the age of 70 years. The overall risk in the population in the corresponding age groups is 2 and 7%, respectively; 28–44% of women have an increased risk of developing ovarian cancer, regardless of age.
BRCA-2 is localized on chromosome 17. Expression of this gene increases the risk of developing breast cancer by up to 85%. A blood test for gene polymorphism can detect this mutation.
Monitoring for BRCA carriers includes monthly self-examination, clinical examination twice a year, annual mammography and breast MRI from age 25–30 years. Given the average age of diagnosis for BRCA 1 associated breast cancer at 35–39 years and for BRCA 2 associated breast cancer at 43 and 54 years, screening efforts should begin at an earlier age. Multimodal examinations should include breast MRI, as this is the most sensitive method of examination, annually from 25 to 55 years of age.
“I wanted to see my grandchildren”: Angelina Jolie explained the terrible decision to remove both breasts
Popular Hollywood actress Angelina Jolie, ex-wife of Brad Pitt and mother of five children, had surgery back in 2013 to remove her mammary glands and replace them with implants. The star wrote about the reasons for her action in an article for The New York Times, writes MK.
In particular, the 44-year-old star addressed the issue not only from a medical perspective, but also from a mental health and emotional well-being perspective.
As you know, Angelina's late mother, actress Marcheline Bertrand, died in 2007 at the age of 56 after a ten-year battle with ovarian and breast cancer.
“I lost my grandmother and mother to breast cancer. I remember once holding my mother's hand while she was undergoing chemotherapy, and when she started to turn red, I had to rush to get the nurse. There are now new ways to determine which chemotherapy drug is best for each patient, resulting in fewer terrible side effects,” the article says.
Angelina said that her mother battled cancer for almost ten years. As the actress herself stood in the hospital hallway, waiting for her mother's body to be prepared for cremation, her doctor said that she promised her mother to tell Jolie about her predisposition to cancer. Years later, she had to undergo a genetic test, which showed that she had a gene - the so-called BRCA1.
The actress wrote that the risk of developing breast cancer in women is usually 13 percent. Her rate was much higher: the risk of developing breast cancer was 87 percent, and ovarian cancer - 50 percent. Due to the high risk, specialists recommended that she undergo preventive surgery. Jolie had a double mastectomy and later had her ovaries and fallopian tubes removed.
In the years since Angelina's surgery, advances have been made in genetic diagnosis. Genetic testing has become more accessible and less expensive. Treatments such as check-point inhibitors have emerged to help block the “cloak of invisibility” that cancer cells put on to survive. PARP inhibitors, when used in combination with immunotherapy, may improve the chances of survival of patients with breast and ovarian cancer.
“My friend was recently diagnosed with breast cancer. She had no family history, but despite this, she became ill at age 30. She studied all the latest advances in science and modern procedures. She opted for a mastectomy, removing her breast and nipple. She froze her eggs before she had to undergo chemotherapy and then had breast reconstruction. She showed her battle with cancer through her art to share her experience with others,” notes the star.
The celebrity believes that while stories like these should give us hope, there is still a long way to go. That's because there is currently no reliable screening test for ovarian or prostate cancer, and no effective treatment for the most aggressive forms of breast cancer, known as triple-negative breast cancer.
Angelina Jolie says she feels she made the right choice to improve her chances of seeing her children grow up and have grandchildren.
“I hope to give them as much time as possible. I have been living without my mother for more than ten years. She saw only a few of her grandchildren and was too ill to play with them. My grandmother died at 40 years old. I hope that my choice will allow me to live a little longer,” Jolie writes.
According to her, the deepest scars are often invisible - they are in the soul. All the patients she met at the Curie Institute said that the care and support of loved ones was the most important motivation for fighting the disease.
“Stop turning a blind eye to the abuse of women. Stop preventing girls from getting education or health care. Stop forcing them to marry the person you chose for them, especially when they are still children. Help young girls realize their uniqueness. Help protect the women you know,” the actress urges.
As FACTS previously reported, an interview with Angelina Jolie’s “zombie double”, which she gave in prison, was shown on TV in Iran.
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Forewarned is forearmed
In the USA, removal of mammary glands costs about 50 thousand dollars, and analysis for gene mutations costs about 3.5 thousand dollars. In Russia, such a procedure will cost about 20 thousand rubles, but this is not cheap either. Experts remind that self-prophylaxis is the best way to prevent the disease, especially since it is free.
Honored Russian doctor E. Lilin says that the simplest thing that can be done is to prevent a tumor from developing. Every morning in front of the mirror, a woman should feel her breasts so that there are no lumps, balls or nodules there. UN statistics announced frightening figures. About 500,000 women worldwide get breast cancer every year! Of these, less than 1% inherited cancer. A gene mutation is just one of 700 possible causes of cancer.
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In one of her letters to the New York Times, the actress says that she did not feel worse after this. “On a personal level, I didn’t stop being a woman, but on the contrary, I felt stronger that I was able to make such a difficult choice,” says Angelina Jolie. She perceives the operations that she has undergone and which she still has to undergo as another obstacle on the path to personal happiness.
Mastectomy
Prophylactic mastectomy is common in the United States and Western Europe. Previously, appendicitis and healthy tonsils were easily cut out there. These operations are performed to eliminate the possibility of inflammation. Today, girls who are at risk are offered to get rid of healthy fallopian tubes.
More recently, the principle of the formation of cancer cells in women was discovered. It turns out that they begin to arise precisely in these organs. But whether to cut them or not is something everyone decides for themselves.
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Deputy Director of the Scientific Oncology Center D. Zaridze claims that there are two ways to treat this disease. The first is removal, and the second is active surveillance of women with increased hereditary risks of breast cancer. This means that a woman should be examined every six months, and maybe more often: have a mammogram and an ultrasound examination.
