Hours after actress Angelina Jolie revealed that she had a preventive double mastectomy to reduce her risk of breast cancer, the American Cancer Society issued a statement Tuesday urging women who might have genetic risk factors for breast cancer to proceed with caution before undergoing surgery.
“While only a small number of breast cancers are linked to known genetic risk factors, women facing such a high risk need to know that, and need to be able to discuss their options with genetic specialists and knowledgeable health professionals so they can have all the information and expertise at their fingertips to do what’s right for them,” said a statement from Otis W. Brawley, chief medical officer of the American Cancer Society.
“This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer,” he said. Even if these genetic risks are confirmed through testing, not every woman should should get the surgery.
“Experts recommend women proceed cautiously, and receive a second opinion before deciding to have this surgery,” he said.
Women should know their cancer family history and discuss it with their primary care physician. If appropriate, they should be referred to genetic specialists to discuss their risk and options, he said.
Insurance plans created before the passage of the Affordable Care Act are not required to cover the costs of genetic counseling, testing and any surgery to reduce the risk of breast cancer. But under the health law, new insurance plans are required to cover counseling and testing for breast cancer risk. They are not required to cover the surgery.
Brawley said the preventive surgery to remove both breasts before cancer is diagnosed can reduce the risk of breast cancer by as much as 97 percent. But it does not completely prevent breast cancer because “even a very careful surgeon will leave behind a small amount of breast tissue, which can go on to become cancerous,” he said.
Among the women who could benefit from the surgery are those who have mutations in the BRCA gene associated with a high risk of breast cancer that have been confirmed by testing, a strong family history of breast cancer, a previous breast cancer, and show signs of certain precancerous conditions.
“A woman with a mutation of known significance must consider her quantifiable risk in making the very personal decision to have her breasts and ovaries removed or pursuing other options, such as more extensive screening for breast and ovarian cancer,” Brawley said.