The model Samantha Day, the actresses Christina Applegate, Giuliana Rancic and Kathy Bates … Several American personalities have revealed having had a double mastectomy, to prevent breast cancer or recurrence.
In 2013, one of the icons of absolute femininity, actress Angelina Jolie, published an article in the New York Times in which she announced that she had chosen to undergo a double mastectomy in order to reduce her risk of 87% to 5% of getting breast cancer. She freed the voices of many women.
What is a mastectomy?
Mastectomy or prophylactic mastectomy consists of removing the entire mammary gland inside the breast but also the nipple and the aerole. Sometimes the nipple can be kept, as in the case of Angelina Jolie. The skin is also preserved, as explained by doctors.
Breast reconstruction, with the placement of an implant, is generally carried out in stride. This heavy surgery lasted eight hours for the actress. It leaves irreversible consequences. “It is war surgery, extremely dilapidated”, warns the patients who went through this. They lose their breast tenderness since almost all nerve endings have been removed.
Under what conditions can it be practiced?
Mastectomy can be performed on one or two breasts, after detection of a cancerous tumor, or as prevention. In the case of declared cancer, the decision to have a mastectomy varies according to the diagnosis (history, aggressiveness and location of the tumor). When it is quite large and very centralized, it may be better to remove the breast.
In the case of a preventive measure, the intervention is only offered to women carrying a mutation in the BRCA-1 or BRCA-2 genes – “one in 500 women”, according to specialists. The detection of these predisposition genes is offered to women who are already sick and have characteristics that suggest a genetic risk. If the test is positive, the patient’s daughters or sisters can also submit to it. And then decide to have a preventive mastectomy.
How many women use it?
Doctors figures at “5%” of screened women, those who decide to use a preventive double mastectomy. Against “30 to 40%” of women who didn’t.
However, the media coverage of this practice tends to convince more and more women to take the plunge. Even if they do not carry a mutation of the two genes.
The price itself is also heavy. In France, genetic tests – 2,000 euros according to the doctor’s daily newspaper – and the surgical intervention that can then be performed are covered by health insurance. But in the United States, where healthcare costs are often borne by patients, the bill is heavier and often hinders screening, as deplored by Angelina Jolie.
Is the risk of developing cancer definitively ruled out?
Looking at the numbers, the argument of double breast removal has weight. The probability of developing breast cancer before the age of 70 is estimated to be at least 60% for women with this genetic mutation, and 30% for ovarian cancer. In the case of Angelina Jolie, these figures were “87%” and “50%”, respectively. According to the actress, her risk has fallen to 5% since the operation.
The risk is therefore not completely ruled out but greatly reduced.
Other options, however, exist. While the choice to perform a preventive mastectomy is left to the patient, removal of the ovaries as a preventive measure for women carrying the mutation and aged 40 is systematically recommended by oncologists. Not only does it limit the risks of developing breast cancer, but it appears less symbolically and physiologically violent. In addition, ovarian cancer is more difficult to detect and very aggressive.
Another option: annual monitoring by ultrasound, mammography, MRI, from the age of 30 years. In this case, we must accept the possibility of a diagnosis of breast cancer, even taken very early. A risk that some are not ready to run.
