Preventative double mastectomies on the rise

Angelina Jolie is the latest in a string of famed women to announce she’s had risk-reducing breast surgery after discovering she carries a breast cancer (BRCA) gene. Before her, Michelle Heaton and Sharon Osbourne have also had this major surgery, which can reduce the risk of breast cancer by up to 95%. But what does surgery involve? What are the BRCA genes and how do you know whether you carry one? And while the benefits are clear, what about the risks and disadvantages of preventative surgery? Are there other options for reducing your risk? In this blog, we discuss all of this.

BRCA genes and breast cancer

While risk factors for cancer usually include things like age, lifestyle and diet, in a small number of cases (5–10%), cancer is thought to be caused by an inherited faulty gene. The genes most commonly linked to an increased risk of breast cancer are BRCA1 and BRCA2 (BRCA stands for breast cancer). This means that if there is a faulty BRCA gene in your family, those who inherit it will be at a greater risk of breast cancer than the general population.

If you’re worried about cancer in your family, you may want to tell your GP if you've had:

• three close blood relatives from the same side of the family who developed breast cancer at any age
• two close relatives from the same side of the family who developed breast cancer under 60
• one close relative who developed breast cancer aged 40 or younger
• a close male relative with breast cancer
• a close relative with breast cancer in both breasts.

Online self-assessment tool

If there’s a history of breast or ovarian cancer in your family, use our online tool OPERA to check your risk. OPERA gives you a personalised assessment of your risk with further information and support.

If your GP thinks there may be an increased risk of cancer in your family, they’ll refer you to a genetic counsellor or cancer specialist to assess your cancer risk. You may be offered genetic testing if your family history makes it likely that you may have inherited one of the BRCA genes.

Options if you’re at increased risk

If your GP or genetic counsellor tells you that, based on your family’s history, you may be at an increased risk of cancer, there are several possible options for managing your risk, whether you had a genetic test or not. These include:

• lifestyle changes
• being aware of symptoms
• regular screening
• surgery (explained below)
• research trials, such as using drugs to prevent cancer.

Risk-reducing breast surgery

Risk-reducing mastectomy is major surgery involving a general anaesthetic. During the operation the surgeon removes both breasts. 

There are different types of surgery. A total mastectomy removes the breasts, nipples, areola (the coloured skin around the nipple), and about half of the skin covering the breasts. Various other types of operation preserve the skin of the breasts, the nipple and/or the areola. 

You may like to watch our video of mum Wendy and daughter Becky talking about their experiences of genetic testing and risk-reducing breast surgery. There’s also video of a genetic counsellor explaining the process of assessing your genetic risk.

For more detail, we have a booklet called Understanding risk-reducing surgery, which you can order for free or download as a PDF.

Breast reconstruction

Breast reconstruction is an operation to make a new breast shape after a mastectomy. It can be done at the same time as risk-reducing mastectomy (immediate reconstruction) or some time later (delayed reconstruction).

The new breast shape can be made with a breast implant, by using tissue taken from another part of your body, or by a combination of both techniques.

Some women don’t have reconstruction and prefer to wear breast forms (prostheses/false breasts) instead.

Making your decision

Deciding whether to have a preventative mastectomy is not easy. You may need lots of time to help you make up your mind and you shouldn’t feel rushed into making a decision. What’s right for one woman may not be for another.

We’ve summarised the pros and cons of risk-reducing breast surgery here, which we hope will help if you’re considering this option:

Advantages

• The operation greatly reduces your risk of breast cancer (by about 95%).
• After the operation, most women say they feel much less anxious about getting breast cancer and the impact it could have on their family.
• You won’t need to have breast screening.

Disadvantages

• It can take up to six months or more to fully recover.
• As with all operations, there can be complications.
• Your body won’t look the same and you may not be happy with the change.
• You may not develop breast cancer anyway, even if you don’t have the operation.
• The results of the surgery are permanent. You can’t change your mind once you’ve had the operation.
• If you’re having breast reconstruction as well, you’re likely to need more than one operation to get the best cosmetic result.

Coping with cancer in the family

Living with the threat of cancer in your family can be very difficult. Talking about your worries with relatives may help. If you find it difficult to talk to your relatives, getting support from a partner, genetic counsellor or friend may help.

If you feel that risk-reducing breast surgery isn’t right for you at this time, or you’re unsure about it, talk to your GP or a genetic counsellor about the other options available.

We hope the information here has helped you understand more about breast cancer risk, risk-reducing surgery and other options. If you have any questions or concerns, you can talk them through with our cancer support specialists.

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