Cancer expert urges caution on preventative mastectomies

Cancer expert favours regular screening for at-risk patients unless they are frozen by fear

PUBLISHED : Monday, 20 May, 2013, 12:00am
UPDATED : Monday, 20 May, 2013, 10:56am


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Preventative mastectomies are not encouraged unless the high-risk individuals are overwhelmed by fears of developing breast cancer, according to a breast cancer expert.

Hollywood star Angelina Jolie's announcement of her double mastectomy last week has caused many to ask if they should be tested for the breast cancer genes and if preventive removal is necessary.

Dr Ava Kwong Hoi-wai, University of Hong Kong associate professor and chief of Queen Mary Hospital's breast surgery division, said regular screening was more than 90 per cent accurate, meaning the cancer could be detected at an early stage.

"If you can accept the risk, you don't have to remove your breasts as a preventive measure," she said. "There is no right or wrong, as long as the patient understands the risk."

As for how she usually advises high-risk patients, Kwong said: "I ask them, 'Will you think of it every night and can't sleep? Is it traumatising your life'?" Most people say no, and opt for regular screening.

Private surgeons in Hong Kong charge up to HK$500,000 for a double mastectomy and breasts reconstruction.

The effect of Jolie's high profile action to raise awareness on the disease is also seen in Hong Kong.

Jolie, whose mother died of breast cancer in her mid 50s, found out she has the BRCA1 gene mutation, which meant she had a 87 per cent risk of the disease.

The Hong Kong Hereditary Breast Cancer Family Registry, chaired by Kwong, received about 10 inquiries after Jolie went public.

The registry, which provides consultations and genetic screening for underprivileged high-risk patients, usually gets just two to three inquiries a month.

"It's a good thing that more people became aware of it. There are some who need the test," Kwong said.

There are three main types of people considered eligible for genetic tests - those with a family member who has had breast cancer before age 40; those with several family members having the cancer; or with a male family member having the cancer.

Kwong emphasised that people seeking the genetic test should have proper counselling as a wrong interpretation of the results and not being fully informed of preventive options would make it worse than not having the test.

The three main options for those having BRCA mutations are regular screening; breasts removal, which reduces the risk 90 per cent; and ovaries removal, which reduces the risk of breast cancer 50 per cent and ovarian cancer by 90 per cent.

In Hong Kong, 8.5 per cent of the 914 families tested by the registry had a BRCA mutation, a prevalence similar to the international rate of 8 to 10 per cent.