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Angelina Jolie: Prevent breast cancer through prophylactic breast amputation?
The prophylactic breast amputation of actress Angelina Jolie, which became known on Tuesday, triggered an intensive debate about whether and with whom breast removal for breast cancer prevention makes sense. The actress had publicly reported her breast amputation for the first time yesterday. The breast cancer risk gene BRCA-1 was discovered in a genetic test. Angelina Jolie's mother also died of ovarian cancer at the age of 56, which suggests an increased family risk.
37-year-old Jolie reports that doctors estimated her risk of breast cancer at 87 percent and the likelihood of developing ovarian cancer at 50 percent. In order to minimize the cancer risk, she therefore decided to amputate the breasts. Although this decision was certainly difficult for her, Jolie's improved surgical options may have made the step a little easier. Because today a breast amputation is often hardly noticeable externally. According to the doctors, the operation reduced her breast cancer risk to around five percent, the actress said.
Breast amputation without external changes After a breast amputation (mastectomy), implants can help to largely maintain the original shape of the breast and, thanks to the improved options for intervention, only a few small scars remain in the end, explained Angelina Jolie. So those affected are hardly changed in their appearance and then do not have to live with a physical flaw. Accordingly, the decision to have a breast amputation is much easier to make today than it was just a few decades ago. The genetic tests that enable risk genes to be determined have not been available for so long. A preventive breast amputation was therefore hardly an option in the past. The removal of the breast was rather intended as a treatment measure after the breast cancer diagnosis.
Questionable prophylactic breast amputation Although there is now an option to check the genetic breast cancer risk, the subsequent decision to undergo prophylactic breast amputation based on a risk potential estimated using a genetic test remains controversial. Especially since intensive monitoring of high-risk patients (half-yearly checks) and a corresponding early intervention if breast cancer is actually proven appear to be sufficient here. The American Cancer Society (ACS) has also pointed out that preventive mastectomy only makes sense for very few women. In addition, this radical measure does not completely rule out the risk of breast cancer, since remnants of breast tissue remain in the body and could contribute to the development of breast cancer. Those affected should therefore continue to regularly participate in early detection programs.
Genetic tests to assess the risk of disease The genetic tests are now a widely used diagnostic method that can also provide information on diseases that have not yet broken out. For example, women with a familial high risk of breast cancer (grandmother, mother or siblings suffering from breast cancer) are recommended to carry out a genetic test in order to be able to assess the individual risk of illness. This happened to Angelina Jolie and the doctors came to the conclusion that the actress was about 90 percent likely to develop breast cancer. Comparable genetic tests are also offered in Germany. A corresponding examination can be carried out in one of the 15 centers for familial breast and ovarian cancer within approximately ten days.
Good chances of recovery with early detection of breast cancer. However, even if individual risk genes are detected, it is always an estimate of the cancer risk. It remains to be seen whether the patients would actually develop breast cancer. So the frequently expressed doubts about prophylactic breast amputation seem at least partially justified. Especially when you consider that the treatment options for a very early diagnosis of breast cancer are quite good. Here, an approximately 90 percent chance of healing is assumed. In order to ensure early detection of cancer, those affected must regularly participate in intensified early detection programs, but they may be spared a breast amputation in this way. (fp)
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