Newspaper article The Record (Bergen County, NJ)

Preventive Breast Surgery Gains Acceptance

Newspaper article The Record (Bergen County, NJ)

Preventive Breast Surgery Gains Acceptance

Article excerpt

Angelina Jolie's decision to have a double mastectomy after learning her genes put her at a much greater risk for developing breast cancer is the choice most women now make after learning their DNA poses a threat, North Jersey breast surgeons said.

Jolie announced Tuesday that she opted for the radical preventive surgery after tests revealed she had one of the so-called breast- cancer genes, BRCA 1. She had watched her mother battle cancer for almost a decade before dying at age 56.

Many experts in North Jersey said their patients made the same wrenching choice as Jolie after watching a mother or sister diagnosed with breast cancer endure painful operations, grueling chemotherapy or radiation and learning they themselves carried the genetic mutation.

"The majority of women who test positive opt for prophylactic surgery -- I'd say upwards of 75 to 80 percent," said Dr. Mary Ann Warden, acting director of breast surgery at Hackensack University Medical Center.

A mutation in either BRCA 1 or BRCA 2 genes increases the risk of developing breast cancer as much as 87 percent and up to 44 percent for developing ovarian cancer by age 70, experts say. Surgery reduces that risk to less than 5 percent for developing cancer.

Ten years ago, preventive mastectomies were considered a radical move. Now, Dr. Laura Klein said, most patients who test positive for the mutation opt for surgery -- though they may take years to make that decision. Some opt for close monitoring while they marry and have children and others need time to weigh the risk of developing cancer against the prospect of removing healthy breasts or ovaries and forever changing their bodies.

On Tuesday morning, Klein, medical director of the Valley Hospital Breast Center in Ridgewood, was preparing to operate on a patient in her late 30s who had tested positive for the mutation two years ago. "She has her life in order, she's done all of her research and she's processed all of this," Klein said.

Still, Klein stressed that not everyone who has the faulty genes develops cancer and testing can't predict at what age cancer is likely to strike. "It's not simple," she said. "There are modifying genes that exist."

If they don't want to have preventive surgery, women who test positive can opt for increased testing: more frequent mammograms, ultrasounds and MRIs. To detect ovarian cancer in its earliest stages, women can undergo trans-vaginal ultrasounds and blood tests.

Women's fears

Genetic testing can be fraught with anxiety. Women fear the news. They worry they might lose their health or life insurance or worse - - learn they have passed on dangerous mutations to their children.

"It's a very complex social, legal and ethical issue," said Patricia Mazzola, coordinator for the High Risk Program at Englewood Hospital and Medical Center. …

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