Post on 15-Jan-2016
SUMAYYA EBRAHIM GYNAECOLOGIST
PARKLANE CLINIC JOHANNESBURG
NATIONAL CANCER REGISTRY
Lifetime risk of ovarian cancer 1:82
Lifetime risk of breast cancer 1:29 (2004)
BRCA 1 and BRCA2 mutations:
5-10% breast cancers
10-15% ovarian cancers
(white women in USA)
Tumour supressor gene
Breast cancer susceptibility gene 1 (BRCA 1)
Breast cancer susceptibility gene 2 (BRCA 2)
BRCA 1 general population 1:500-1:800
BRCA 2 lower
Ashkanazi Jewish Descent 1:40
Increased cancer risk
Breast cancer risk 5x higher
Ovarian cancer risk 3-5 x higher
SURVEILLANCE
RISK AVOIDANCE
PROPHYLACTIC SURGERY
BREAST CANCER:self examination mammograms MRI
OVARIAN CANCER:clinical examinations vaginal ultrasound Ca125 level
Reduction in body fat
Reduction in alcohol intake
Reduced dietary fat
Increase physical activity
BILATERAL PROPHYLACTIC MASTECTOMY
BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY
Complete removal of both breasts
Including nipples:TOTAL MASTECTOMY
Nipple conservation:NIPPLE SPARING 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
BRCA1 BRCA2 MUTATIONS Expected risk reduction of 95%
STRONG FAMILY HISTORY Expected risk reduction of 90%
Irreversible
Expensive :multiple operations time consuming days off work
Procedure related complications:infection bleeding
Psychological:change in body image
Removing both the ovaries and fallopian tubes
High risk women
BRCA 1 and BRCA 2 mutations
Premenopausal
Older than 35
Completed families
IN HIGH RISK WOMEN
Expected risk reduction of ovarian cancer 90%
Expected risk reduction of breast cancer
50%
Permanent and irreversible
Surgical complications:infection ; haemorrhage ;intestinal obstruction
Immediate surgically induced menopause discomforts osteoporosis heart disease memory loss and dementia
WITH NO HRT Higher rate of premature death,cancer, heart disease and neurological disease
HRT?????????
RISK REDUCING SURGERY FOR ALL?