The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer

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The Angelina Jolie Example Risk Reducing
Surgery for Breast and Ovarian Cancer

• SUMAYYA EBRAHIM
• GYNAECOLOGIST
• PARKLANE CLINIC
• JOHANNESBURG

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MAY 2013
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STATISTICS SOUTH AFRICA

• NATIONAL CANCER REGISTRY
• Lifetime risk of ovarian cancer 182
• Lifetime risk of breast cancer 129 (2004)

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GENETIC CANCERS

• BRCA 1 and BRCA2 mutations
• 5-10 breast cancers
• 10-15 ovarian cancers
• (white women in USA)

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BRCA

• Tumour supressor gene
• Breast cancer susceptibility gene 1 (BRCA 1)
• Breast cancer susceptibility gene 2 (BRCA 2)

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INCIDENCE OF BRCA

• BRCA 1 general population 1500-1800
• BRCA 2 lower
• Ashkanazi Jewish Descent 140

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CANCER RISKS WITH BRCA

• Increased cancer risk
• Breast cancer risk 5x higher
• Ovarian cancer risk 3-5 x higher

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OPTIONS WITH BRCA

• SURVEILLANCE
• RISK AVOIDANCE
• PROPHYLACTIC SURGERY

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SURVEILLANCE

• BREAST CANCERself examination
• mammograms
• MRI
• OVARIAN CANCERclinical examinations
• vaginal ultrasound
• Ca125 level

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RISK AVOIDANCE

• Reduction in body fat
• Reduction in alcohol intake
• Reduced dietary fat
• Increase physical activity

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PROPYHLACTIC SURGERY

• BILATERAL PROPHYLACTIC MASTECTOMY
• BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY

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PROPHYLACTIC BILATERAL MASTECTOMY

• Complete removal of both breasts
• Including nipplesTOTAL MASTECTOMY
• Nipple conservationNIPPLE SPARING MASTECTOMY

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TOTAL BILATERAL MASTECTOMY WITHOUT RECONSTRUCTION
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TOTAL BILATERAL MASTECTOMY WITH RECONSTRUCTION IN
PROGRESS
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TOTAL BILATERAL MASTECTOMY WITH COMPLETED
RECONSTRUCTION
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CANDIDATES FOR P.MASTECTOMY

• Known BRCA1 and BRCA2 mutations
• Strong family history without BRCA mutations
• Lobular carcinoma in situ(LCIS)family history
• Radiation to chest wall before 30 years of age
• Cancer in one breast

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BENEFITS OF P. MASTECTOMY

• BRCA1 BRCA2 MUTATIONS
• Expected risk reduction of 95
• STRONG FAMILY HISTORY
• Expected risk reduction of 90

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DRAWBACKS OF P.MASTECTOMY

• Irreversible
• Expensive multiple operations
• time consuming
• days off work
• Procedure related complicationsinfection
• 
  bleeding
• Psychologicalchange in body image

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BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY (BSO)

• Removing
• both the ovaries and
• fallopian tubes

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TECHNIQUES FOR BSO
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CANDIDATES FOR BSO

• High risk women
• BRCA 1 and BRCA 2 mutations
• Premenopausal
• Older than 35
• Completed families

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BENEFITS OF BSO

• IN HIGH RISK WOMEN
• Expected risk reduction of ovarian cancer
• 90
• Expected risk reduction of breast cancer
  
• 50

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DRAWBACKS OF BSO

• Permanent and irreversible
• Surgical complicationsinfection haemorrhage
  intestinal obstruction
• Immediate surgically induced menopause
• discomforts
• osteoporosis
• heart disease
• memory loss and dementia

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BSO AT WHAT COST ?

• WITH NO HRT
• Higher rate of premature death,cancer,
• heart disease and neurological disease
• HRT?????????

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CONCLUSION

• RISK REDUCING SURGERY FOR ALL?

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