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The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer

The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer. SUMAYYA EBRAHIM GYNAECOLOGIST PARKLANE CLINIC JOHANNESBURG. MAY 2013. STATISTICS SOUTH AFRICA. NATIONAL CANCER REGISTRY Lifetime risk of ovarian cancer 1:82

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The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer

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  1. The Angelina Jolie Example :Risk Reducing Surgery for Breast and Ovarian Cancer SUMAYYA EBRAHIM GYNAECOLOGIST PARKLANE CLINIC JOHANNESBURG

  2. MAY 2013

  3. STATISTICS SOUTH AFRICA NATIONAL CANCER REGISTRY Lifetime risk of ovarian cancer 1:82 Lifetime risk of breast cancer 1:29 (2004)

  4. GENETIC CANCERS • BRCA 1 and BRCA2 mutations: • 5-10% breast cancers • 10-15% ovarian cancers • (white women in USA)

  5. BRCA • Tumour supressor gene • Breast cancer susceptibility gene 1 (BRCA 1) • Breast cancer susceptibility gene 2 (BRCA 2)

  6. INCIDENCE OF BRCA • BRCA 1 general population 1:500-1:800 • BRCA 2 lower • Ashkanazi Jewish Descent 1:40

  7. CANCER RISKS WITH BRCA • Increased cancer risk • Breast cancer risk 5x higher • Ovarian cancer risk 3-5 x higher

  8. OPTIONS WITH BRCA • SURVEILLANCE • RISK AVOIDANCE • PROPHYLACTIC SURGERY

  9. SURVEILLANCE • BREAST CANCER:self examination • mammograms • MRI • OVARIAN CANCER:clinical examinations • vaginal ultrasound • Ca125 level

  10. RISK AVOIDANCE • Reduction in body fat • Reduction in alcohol intake • Reduced dietary fat • Increase physical activity

  11. PROPYHLACTIC SURGERY • BILATERAL PROPHYLACTIC MASTECTOMY • BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY

  12. PROPHYLACTIC BILATERAL MASTECTOMY • Complete removal of both breasts • Including nipples:TOTAL MASTECTOMY • Nipple conservation:NIPPLE SPARING MASTECTOMY

  13. TOTAL BILATERAL MASTECTOMY WITHOUT RECONSTRUCTION

  14. TOTAL BILATERAL MASTECTOMY WITH RECONSTRUCTION IN PROGRESS

  15. TOTAL BILATERAL MASTECTOMY WITH COMPLETED RECONSTRUCTION

  16. CANDIDATES FOR P.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

  17. BENEFITS OF P. MASTECTOMY • BRCA1 BRCA2 MUTATIONS • Expected risk reduction of 95% • STRONG FAMILY HISTORY • Expected risk reduction of 90%

  18. DRAWBACKS OF P.MASTECTOMY • Irreversible • Expensive :multiple operations • time consuming • days off work • Procedure related complications:infection • bleeding • Psychological:change in body image

  19. BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY (BSO) • Removing both the ovaries and fallopian tubes

  20. TECHNIQUES FOR BSO

  21. CANDIDATES FOR BSO • High risk women • BRCA 1 and BRCA 2 mutations • Premenopausal • Older than 35 • Completed families

  22. BENEFITS OF BSO • IN HIGH RISK WOMEN • Expected risk reduction of ovarian cancer • 90% • Expected risk reduction of breast cancer • 50%

  23. DRAWBACKS OF BSO • Permanent and irreversible • Surgical complications:infection ; haemorrhage ;intestinal obstruction • Immediate surgically induced menopause • discomforts • osteoporosis • heart disease • memory loss and dementia

  24. BSO AT WHAT COST ? • WITH NO HRT • Higher rate of premature death,cancer, • heart disease and neurological disease • HRT?????????

  25. CONCLUSION • RISK REDUCING SURGERY FOR ALL?

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