BRCA突变是否应该是双乳房切除术的依据？

Would double mastectomy be needed to reduce breast cancer?  No.  Many other risk factors than breasts are more important for the development of breast cancer.

Angelina Jolie, actress, filmmaker, and human rights activist was found to be a BRCA1 gene mutation carrier.  She opted to undergo double mastectomy – removal of both breasts as a preventative measure.

Angelina’s choice is the best advertisement for the doctors and hospitals. Audiences respect the famous actress and her action can influence many people.  It would not be a surprise that many women when they are found to carry BRCA mutations would follow Angelina’s steps – to receive double mastectomy.

The question is, is double mastectomy necessary for BRCA carriers to prevent breast cancer or helpful for breast cancer patients with BRCA mutations?  The simple answer is, double mastectomy does not help breast cancer patients with BRCA gene mutation(s).  And women with BRCA mutations do not have to remove breasts to prevent breast cancer.

How to understand the risk from BRCA mutations?

Normal BRCA genes are helpful because they produce proteins that help repair DNA mutations.  BRCA mutations may lead to the loss of this protection and carriers of the mutations are thus at higher risk for breast cancer and ovarian cancer.

But remember this.   Not all BRCA mutations are harmful.  Some BRCA mutations can actually help DNA repair.   So doctors do not convey the entire message about BRCA mutation.

Just because you are a BRCA1 and or BRCA 2 mutation carrier does not mean you are destined to develop fetal breast cancer.  You can take control of your fate.  Yes, some data indicate that women with these mutations at more likely to develop breast cancer.  But these data DO NOT indicate that ALL carriers should have to develop breast cancer.

Let us ask us a simple question, why some women with BRCA mutations do not develop breast cancer while others develop it?  The difference can be explained with epigenetics.

Epigenetics is a branch of genetics telling us that environmental factors can influence gene expressions.  That is, the same gene under different environmental conditions such as diet, nutritional status or mental condition can behave differently.  That is why some BRCA mutation carriers develop breast cancer while others do not.  This difference is due to the difference in the diet and lifestyle individuals follow.  Unfortunately, the cancer industry is not interested in finding exactly what causes the difference or what foods or lifestyle factors can help prevent or treat breast cancer.

Doctors do not know that cancer risk can be reduced by following a healthy diet and lifestyle.   They do not care nor want to know how to prevent breast cancer.  They are trained to believe that double mastectomy can help prevent breast cancer and thus prevent death from breast cancer.  Or this surgery can help increase the odds of survival.

BRCA mutations per se do not cause breast cancer.  Normal BRCA gene expression prevents the DNA damage induced by carcinogens like toxic chemicals and medical radiation and environmental pollutants.  Exactly the same risk factors also cause more than 95% of the total breast cancer cases.  So no matter you are a BRCA carrier or not, you need to get rid of those risk factors to reduce your breast cancer risk.  It is not wise to rush to remove breasts as a measure to prevent breast cancer.

Fortunately, mutated genes are not the largest factor for he risk of breast cancer.  In old days, the risk of BRCA mutations may be higher because we did not know much about the potential environmental risk factors.  At this time, we have known so many things women can do to prevent breast cancer.  Even for women with diagnosed breast cancer, women can do so many things to help treat their breast cancer and increase their likelihood of long term survival.  For instance, evidence indicates that exposure to toxic chemicals or other factors such as stress and following unhealthy lifestyle is responsible for as much as 95% of the factors associated with all diseases.

You as a BRCA carrier may not know exactly what to do reduce the risk of breast cancer. But you do not know based on the information from the cancer industry and the governments that not all BRCA carriers develop breast cancer.  If you figure out why some carriers do not develop breast cancer, you would not want to remove your breasts.

For treatment?

Does double mastectomy help breast cancer survival?  No.

A recent study published in a prestigious medical journal – the Lancet indicates that double mastectomy can do not increase odds of survival!  Breast cancer patients with BRCA mutations have virtually the same odds of survival as those breast cancer patients with non BRCA mutations.  That study even found that triple negative breast cancer patients with BRCA mutations have an survival advantages over those non-carriers.

This study indicates that double mastectomy may not be justified for BRCA carriers with diagnosed breast cancer.

In any case, many things BRCA carriers can do to reduce their risk of breast cancer.  Double mastectomy is not needed as a preventative measure or treatment for BRCA mutation carriers.