Women at Risk of Breast Cancer Making Similar Choices
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
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
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.