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Women at Risk of Breast Cancer Making Similar Choices

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WebMD Health News

June 8, 2000 -- Despite medical advances, breast cancer still strikes fear in the hearts of women worldwide. According to a Dutch study in the June 10 issue of The Lancet, most young women with mothers or sisters who have had breast cancer, and who themselves have children, will choose to be tested for the breast cancer gene BRCA if they have access to testing. And over half of those who learn they have the gene will decide to have their breasts removed just to be on the safe side.

Women who have the gene have a 50% to 80% risk of getting breast cancer. These women are also more likely to develop cancers when they're young, and to have more serious types of cancer. Surgical removal of the breasts, called preventive mastectomy, can reduce the risk of breast cancer by about 90% in these women.

The senior author of the new study, Jan G.M. Klijn, MD, PhD, tells WebMD that among those women with children, 83% under age 50 chose to be tested for the gene. After age 50, 40% of women chose to be tested. Klijn is a professor of medical oncology and chair of the Rotterdam Family Cancer Clinic in Rotterdam, Netherlands.

After receiving their test results, Klijn reports that over half of the women with the gene had preventive mastectomies. This included a high of almost 70% of women in their early 30s, down to 11% of women over age 55.

Stephen E. Karp, MD, who was not involved in the study, says that more patients and physicians are becoming convinced that preventive mastectomy is a reasonable choice for some women who discover that they have these dangerous gene defects. Karp is assistant professor of surgery in the division of surgical oncology at the Medical College of Virginia in Richmond.

Karp says that the over-50% rate of mastectomy in the Dutch study is very high, but might partly reflect the fact that all of these women were from families with a known, high incidence of serious breast cancer. "In my experience, nobody wants a mastectomy, but women who have seen their mothers or sisters die at an early age are more likely to be ready to give up their own breasts to increase their safety," Karp says.

Parenthood was a strong factor in the Dutch women's decisions. "Most younger women with children chose mastectomy. These women want to be there to watch their children grow up, and many have themselves seen their mothers or sisters die at age 30 or 40 from breast cancer," Klijn says. About 60% of women with children chose mastectomy, vs. 14% of childless women.

Access to screening was not an issue for the Dutch doctors, but Karp says that it does affect many of his patients. "Many choose not to be tested ... because they have no insurance or their insurance will not pay for the $2,000 test." He adds that he's had patients who have breast cancer in their families who chose a preventive mastectomy that their insurance companies paid for, even though they weren't sure they had the BRCA gene. "I think it is criminal not to provide the funding that would enable us to avoid mastectomy for women who do not need it," Karp says.

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