Breast cancer: Few takers for mastectomy in India

For celebrities like Hollywood actor Angelina Jolie,a decision to remove her breasts,as daring as it may sound,has reduced her risk of cancer by more than 80 per cent.

Written by Anuradha Mascarenhas | Published: May 16, 2013 2:24:51 am

For celebrities like Hollywood actor Angelina Jolie,a decision to remove her breasts,as daring as it may sound,has reduced her risk of cancer by more than 80 per cent. But back here in India,there are few takers for a bilateral prophylactic mastectomy (removal of breasts),say oncologists.

Speaking to Newsline,oncologist Dr Sudeep Gupta of Tata Memorial Hospital said removal of a breast as a prophylactic measure is not wrong — it is among the best treatments in avoiding cancer — but it is not the only option.

Women tested positive for BRCA 1/BRCA 2 gene mutations comprise about five per cent of the 3,000 new cancer cases detected each year at Tata Memorial Hospital. Women can undergo a gene test here and are offered the option of undergoing a bilateral prophylactic mastectomy. But there very few women who actually opt for it. “We then advise them to keep a close watch on their condition,” Gupta added.

Breast cancer susceptibility genes BRCA1 and BRCA2,found in humans,belong to a class of genes known as ‘tumor suppressors’. Mutation of these genes has been linked to hereditary breast and ovarian cancer.

Existing data suggest that preventive mastectomy may significantly reduce (by about 90 per cent) chance of a woman developing breast cancer in moderate and high-risk women “However,no one can be certain that this procedure will protect a woman from breast cancer,” Devieka Bhojwani,vice-president of Women’s Cancer Initiative at TMH said. “It takes a lot of guts to do what Jolie did. We aim to step up awareness for early detection of cancer,” she said.

According to Dr Mandar Nadkarni,oncologist at the Ambani hospital,breast reconstruction is a complex procedure and it takes time. For a woman in her 40s or 50s,it is easier to remove abdominal tissue like skin and fat and use it to reconstruct her breast. “However for women in their 20s,who have not undergone pregnancy and possibly do not have enough abdominal tissue,the procedure is very difficult.”

Nadkarni also pointed out that in case of celebrities,mastectomy is followed by cosmetic reconstruction using silicon implants,in which case the breasts no longer have any functional use. “In the past 11 years,I have had four patients who had tested positive for BRCA 1 or BRCA 2 gene mutation,three of whom had refused to remove their breasts,” he said.

Oncoplastic surgeon Dr C B Koppiker,who spearheaded the Prashanti Cancer Care Mission in Pune,told Newsline that there were women who don’t want to remove their breasts despite developing cancer. “But after a few sessions with our medical counsellors,they come to understand the risks involved and become open to the option.”

Koppiker cited data compiled by the 2006 Pune Cancer Registry,a unit of Indian Cancer Registry Programme,which shows that out of total 1,493 women who developed cancer,469 were patients of breast cancer.

According to the Indian Council of Medical Research (2006),breast cancer is the most common form of cancer among Indian women,accounting for about 19.3 to 27.5 per cent of all cancer patients among women across India. The proportion is around 30 per cent in case of Pune.

Worldwide reports suggest that mutations in BRCA1 and BRCA2 are responsible for at least 20 per cent of familial cases of breast and/or ovarian cancer. The contribution of BRCA2 mutations seems rather low among Indian women,Koppiker said,quoting previous studies.

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