Is Angelina Jolie's double mastectomy the only route to breast cancer prevention?

The beautiful face of Angelina Jolie was printed across the media recently due to her announcement of “prophylactic” mastectomies.  Ms. Jolie tested positive for a gene BRCA1 which can increase a woman’s chance for breast cancer.  Ms. Jolie lost her mother at age 56 after a 10-year bout with cancer. 

Almost 232,000 new cases of breast cancer are diagnosed every year and 40,000 women die from it annually.  The two genes most commonly associated with breast cancer are BRCA1 and BRCA2.  These represent probably less than 10% of all breast cancers.  There are other genetic markers that can pre-dispose someone to develop breast cancer and some yet to be discovered.  

In short, there are multiple genetic markers for breast cancer but BRCA1 and BRCA2 are the most common ones studied.  They also have a link to ovarian cancer as well.  Having one or both of these genes raises a woman’s risk of breast cancer to about 60% in her lifetime, compared to a normal risk in the range of 8% to 12% for the general population.

Test for these genes costs around $3,400.00 and many insurance plans will cover it.  The route Ms. Jolie took was radical but understandable.  If someone has a strong family history of breast cancer AND tests positive for those genes, careful consideration for bilateral mastectomies should be entertained. 

As a board certified Fort Myers plastic surgeon, I believe the stronger the family history for breast cancer, the more one should consider this route.  Breast reconstruction following mastectomies is in most cases a safe, outpatient procedure.  

But, there are other, more conservative, options such as semi-annual mammograms with ultrasound, MRI or as some physicians believe, thermography.  Some patients may benefit from tomoxifin.  As always, other things a person can do to lower their chances of developing breast cancer is to lead a healthier lifestyle,  ie. no smoking, maintaining a healthy weight, limiting alcohol intake, exercising on a regular basis and a staying on a healthy diet.

In any event, if any signs of breast cancer active or prospective appear, get thee to a physician quickly for diagnosis.

Talking about Breast Cancer

As a Board Certified Cosmetic Surgeon in Fort Myers & Cape Coral, Florida, I am a subscriber to news from the ASAPS. From time to time they send helpful articles, one of which is reprinted (by permission) below. Talking About Breast Cancer

Fighting cancer is a battle within itself. The shock of the diagnosis, treatment and the knowledge that it threatens your life, possibly affecting later generations can be overwhelming. A major step in starting the treatment and healing process is to get the support of your family and friends. Sharing the diagnosis with them can be traumatic for both those giving and receiving the hard news. The American Cancer Society has some recommendations for  talking about cancer: - If you are diagnosed, it’s important for you to discuss in detail with the doctor about the treatment, prognosis and what to expect in the months to come. Knowing all the details and course of treatment will be important so that you can become emotionally ready to share the news. - It might be difficult to talk about cancer over and over again. So, you might feel the need to tell groups of people - via email, cards or people you designate to spread the news. Whatever way you choose to tell another or how much you are willing to share is personal. Those receiving the news  should be respectful of that personal nature. - Having a support group of close family and friends is important and healthy during this time. You may want to reach out to a community group of other cancer survivors during this time, to share experiences. - A common misconception is that the cancer patient or supporting friends and family should act happy and put up a false front. It’s more important to stay positive, but completely normal to have bad days. An even harder task with an illness like breast cancer is talking to young children about the diagnosis. A recent Huffington Post article recommends being honest about cancer to let children know that they’re part of the family, that telling the truth is important and to quell any fears they might have. Here are some tips on talking to children about breast cancer: - Let them know you are sick and you have breast cancer. Children are perceptive. It's important to tell them the real name to avoid mixed messages and confusion. - Tell them in simple and straightforward terms about what to expect. For example: I will be going to the hospital for four nights to be taken care of by doctors and nurses. Then, I’m going to come home and rest here with you and Daddy. - Encourage children to ask questions. Be sure to explain that cancer is not contagious, that no one caused the cancer (in case they think it’s linked to their bad behavior) and that someone will be there for them when you are undergoing treatment. For family members and friends, the best thing to do is be available, supportive and act normally. Following a routine, enjoying hobbies and activities will help bring normalcy and a welcome distraction from possible treatments and surgery.

NEW TECHNIQUE FOR BREAST RECONSTRUCTION

As a Fort Myers plastic surgeon, I find breast reconstruction to be very popular among women who have undergone a mastectomy.

One of the most common forms of breast reconstruction is to put a tissue expander at the site of the mastectomy – expand it over several months – then replace it with a permanent prosthesis. This process can take several months.

A company called Air Expanders has developed an expander that patients, with the help of a remote control can expand the area in a much shorter period of time – instead of months maybe only a couple of weeks.

No more needles – and the patient can decide just how big they want to be. The studies with this new device are being done at New York Presbyterian hospital. The doctor conducting the study is Dr. Jeffrey Ackerman.

LUMPECTOMY FOR BREAST CANCER

Today, many women will bypass a mastectomy for a lumpectomy followed by chemotherapy and/or radiation.

A recent article in the Journal of the American Medical Association revealed that one in four (25%) of patients undergoing this therapy will undergo a second operation.

This creates a significant degree of anxiety along with many questions about the patients future – how deformed will it be? Did it spread?

There is a sincere sense of anxiety and stress associated with this. I also think a patients personality and sense of body image may come into play when making a decision on what therapy is best for her.

THE “NEW” PAP SMEAR

We are all familiar with the pap smear – millions of American women get them every year.

As a Fort Myers plastic surgeon who deals with women who may be, or have been, afflicted by breast cancer, I'm pleased to report that there may be a new “pap” smear to detect breast cancer.

A new partnership between the University of North Dakota and a company called Neomatrix LLC may soon license a new technology to detect early forms of breast cancer from nipple aspirate fluid (NAF).

The HALO test may detect breast cancer cells in the NAF. Researchers at the university identified a set of bio markers in the NAF that led to a diagnosis of breast cancer.

If you would like more information go to www.neomatrix.com. The test is a simple non invasive 5 minute test. This HALO Breast Pap test is FDA approved for the collection of nipple aspirate fluid (NAF).

PROPHYLACTIC MASTECTOMY

Many surgeons are concerned with the increasing trend among women to request removal of their other “normal” breast after undergoing a mastectomy.

Many women voice concerns about developing cancer in the “other” normal breast. Why is this?

There are several reasons. One – fear of recurrence. Two – new technology such as MRI can pick up miniscule lesions not seen on normal mammograms. Third – many women are getting genetic testing to see if they carry BRCA-1 and BRCA-2, genes associated with an increased cancer risk.

Even after a “double mastectomy” the risk of breast cancer is reduced by 90% - NOT 100%. Tumors can still grow back in scar tissue or under the arm where extra breast tissue may be located.

Careful planning with your surgeon trumps decision making out of fear. Dr. Brueck offers general guidance on his Fort Myers Plastic surgeon web site. You are invited to visit.

Sparing the nipple is okay.

This is another message from blogger Dr. Robert Brueck MD, who practices plastic surgery in Fort Myers.

Plastic surgeons were always concerned that sparing the nipple during mastectomy may cause a greater recurrence following breast cancer surgery.

A recent article in Plastic and Reconstructive Surgery reports that 20 years of research shows there is NO greater incidence of breast cancer in nipple sparing mastectomies.

This technique however is not right for all women. Women with more advanced cancer or large pendulous breasts may require a standard mastectomy.

GREAT STORY - New Drug for Breast Cancer

Dr. Robert J. Brueck MD, Fort Myers cosmetic surgeon, frequently blogs here about matters of health, skin care, medicine and cosmetic surgery. Additional information health and cosmetic surgery procedures may be found at Dr. Brueck's website, Beauty-by-Brueck.com

Drug research and development is a very expensive frustrating and in many cases rewarding endeavor. Many of our current "miracle Drugs" have a very unique and interesting beginning.

One such story involves a new drug recently approved by the FDA for breast cancer by the name of Haloven (equally interesting is how they get these names).

Haloven comes from a compound called halicondrin B which was isolated from a black sponge that lives off of the coast of Japan. This substance was found to block cell division in a somewhat unique way. Collaboration between researchers of the National Cancer Institute and Eisai of Japan led to commercial production of Haloven which is one of the most complex small molecule drugs ever made commercially.

Many drugs derived from nature can have nasty side effects and damage normal cells. Researchers study a disease process and then look for "targeted" drugs to interrupt or change the path of development.

Some of the more common drugs you may know have their origin in "nature."

Aspirin comes from willow bark. The active ingredient in salicylic acid. Malaria has been in the news a lot and one of the more common remedies in glunine which comes form the bark of the cinchona tree. Taxol, a very common drug used to treat breast cancer comes form the Pacific yen tree.

So you never know what treasure lies in your backyard waiting to be discovered.

"Miracle Drug" May Treat Breast Cancer - Dr. Brueck, Fort Myers Breast Surgeon Reports

This report by Dr. Robert J. Brueck, Board Certified Plastic Surgeon
practicing in Fort Myers and Cape Coral, Florida, is one in a series presenting news which comes to Dr. Brueck's attention and may be of medical interest to his patients.
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At one time, promoters of aspirin and its manifold therapeutic values described the little white pill as a "miracle drug". Now it appears there may be another therapeutic achievement of aspirin.

A recent report in the Journal of Oncology was based on a study called the Nurses’ Health Study, done at the Brigham and Women’s Hospital in Boston.

It covered a group of women who were diagnosed with breast cancer and included over 4,000 participants. The study occurred from 1976 to 2002, with a follow up continued in 2006.

It was interesting because they found that women who consumed 2 to 5 tablets of aspirin a week had a lower incidence of recurrence and it decreased their risk of dying from the disease by 50%.

The question becomes what effect did the aspirin have?

Epidemiologists at Harvard who were part of this study say that more data is needed and more studies are needed. They don’t really understand why this association occurs but it is a very important study and there may be some beneficial effects from taking aspirin if you have been diagnosed with breast cancer.

Many individuals take aspirin because they have arthritis or are concerned about clotting following MI’s so aspirin may have more benefits than we realize and it is one of the cheapest pharmaceuticals that you can buy over the counter.

The article appeared in the Journal of Clinical Oncology. It was called the Nurses’ Health Study.

Stay tuned. More will be coming. I think it is a very important study and may have some impact of women who suffer from breast cancer.

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For more information about Dr. Brueck, visit his web site at http://www.Beauty-by-Brueck.com. Thank you.

Plastic Surgery - Do breast implants cause cancer?

Do breast implants cause cancer?

It's a question I have been asked over and over.

There is a new study published in the "National Journal of Cancer" that suggests women with breast implants have a lower risk for breast cancer. The analysis included 6,222 women in Sweden and Denmark, 80% of whom had silicone implants.

This study represents the longest follow-up to date of women with breast implants . 85% of the women were followed for over 10 years and 50% for more than 15 years.

Based on general population rates, researchers expected 115.62 women out of this study group to have breast cancer, but only 84 cases developed.

This is statistically significant and once again proves the safety and efficacy of breast implants.

For more information about implants for breast augmentation, please visit my Web site at Beauty-by-Brueck.com and click on the link to breast augmentation.