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Double mastectomy can double survival rate in BRCA-related breast cancer

Dr-PeterRogan_1.jpg Dr. Kelly Metcalfe

One to two out of every 100 women has a genetic mutation in their BRCA1 or BRCA2 gene that greatly increases their risk of breast cancer.

Breast cancers in women who carry this mutation often occur earlier in life, and are more aggressive than in women who don’t have the mutation. There is also a greater risk – about a one in three chance – of developing a second, new breast cancer later on.

Dr. Kelly Metcalfe, a professor at University of Toronto and researcher at Women’s College Research Institute in Toronto, received two grants from Canadian Breast Cancer Foundation-Ontario Region to determine whether women with BRCA-related breast cancer who chose to have a double mastectomy (the removal of both breasts) lived longer than women who had only the affected breast removed (single mastectomy).

Her findings, published in February 2014 in the British Medical Journal, show that women who had a double mastectomy reduced their risk of dying from breast cancer within 20 years by almost 50 per cent, largely because they reduced their risk of developing a second breast cancer by having both breasts removed.

“It makes sense,” she says, noting that women who experienced a second cancer were twice as likely to die from the disease. “We know we need to prevent new breast cancers from happening after they’ve had breast cancer.” Indeed, the greatest survival benefit was seen from 10 to 20 years of follow-up, when a second breast cancer would be most likely to affect survival. In this period, the survival benefit from having a double mastectomy was 80 per cent.

While more research is necessary, this study suggests that double mastectomy may be a more effective treatment for women with a BRCA mutation to prolong their lives, and that women who are diagnosed with breast cancer may be able to make better treatment decisions if they know about their BRCA mutation. Dr. Metcalfe has recently started a study involving a rapid genetic test for newly diagnosed breast cancer patients that could result in more informed decision-making for BRCA mutation carriers. Referring to the survival benefit of a double mastectomy for BRCA-related breast cancer she says, “There are not very many things we can do for patients with breast cancer that would reduce their mortality this much.”