BREAST CANCER SURGERY: AFTER ANGELINA JOLIE’S MASTECTOMY
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Breast cancer is most prevalent Cancer in world about 22.9% of all invasive cancer and 16% of overall cancers
of Woman in world and about 4.5 lakh deaths occur due to it in World,Although a disease more seen in developed countries like USA OR UK 60-80 PER 1000 BUT ONL18 PER THOUSAND IN SOUTH EAST ASIA BECAUSE OF THEIR MODERN LIFE STYLE,obesity,high riched fatty food,less exercise,use of oral contraceptive,late marriage and less use of Breast for Breast feeding ,abortion,ecessive smoking,taking of Alcohol,less iodine and age and sex is important.It occurred after age of 50 in woman and above 60yrs of age in men and also common in woman in comparison to men.
This cancer has reached most discussed point after OSCAR WINNING ACTOR Mrs Angelina Jolie removed her both breast with a fear of getting Breast cancer in her life as one of her cousin had breast cancer and her mother died of Ovarian cancer at age of 56 yrs few years back and she is carring two genes BRCA1 and BRCA2 gene in her blood (these genes is responsible for 87% of cancer in breast and 40-50% of cancer in ovaries in woman and responsible for cancer of prostate and testicles in male not breast),she has told after surgeries that now she can enjoy her life with family without any fear and win over cancer-and her fans and advocates of such surgeries and so called person realted to war over cancer are heighlighting this like any thing and many person affected with cancer or who are at risk like Angelina or having any relative are thinking in the same line or are bound to think ,similisrly Hospitals/ Doctors ,Gene testing laboratories want to exploit her example to earn more money for submitting patients for surgery and earn by advising Gene test ,a patent law will be shortly passed by US COURT and therby hugh profit for company doing this test in coming days from whole world.
Therefore debate is open does Angelina did right thing or not,regarding this,to overcome mental trauma she took personal decision in consultation with her cancer doctors and family,so nobody including me has got no right of any comments but her decision should be extorted and twisted by MEDICAL MARKETING is always questionable.
Gene accounts for only 4-5%of total cancers of breast and ovaries in female so removing breast is not giving immunity for ovarian cancer too,Angelina has to remove ovaries now also ,after removing ovaries she has to undertake oesstrogen progesterone hormone for premenopausal symptoms which may cause thromboembolism,,weight increasing,stroke,hypertension ,cancer of uterus etc.So complete agony not achieved as mentioned.Secondly out of these gene mutation cancers 90% are due to BRACA genes but other Gene changes like p53,stk11,palb2,pten also exist so not only these genes many genes has to be studied and these are costly investigations and they should be done after 30 yrs of age if three members as daughter,mother,sister or grand daughter is affected in family .if lady has got cancer in a breast ,had radiations dur to multiple Mammography,is on estrogen therapy,heve cancer like lobular carcinoma in situ or ovarian cancerlady has got dense breast wher mammography is controversial in these condition PROPHYLACTIC MASTECTOMY 9REMOVAL OF BOTH BREAST) may be done after age of 50 not at 38 as done by Angelina on strong discussion with family and doctors and self decision as removal of breast cures 87% only,lady may have ovarian cancer ,should have regular mammography regularly which is difficult to do in Postmastectomy Silicon water filled implants used to construct breast after such surgeries as cancer is not completely removed as some breast tissue may remain even after good surgery,secondly operation is abig surgery requiring good cost,and chance of scar formation,infection,discharge,bleeiding,and long stay may be required for bsuch big surgery where to reconstruct breast surgey by silicon implants or tissue flaps are done in same sitiing or after 6-8 wks of first surgerywhere nipple with areola may be removed or preserved.
Therefore most Medical literature is of opinion that ladies should not adopt Angelin’s decision immediately and ask for costly Gene tests and ask for such surgeries if any one in family tree of three generation is involved with cancer of Breast or ovary as mandatory or with great fear.
Now a days a question of regular Mamography has ben raised as it causes no less mortality and reduce incidence of breast cancer but submit mor than 30% more unneccary surgeries and radiation to breast causing cancer.
So highly susceptible should do regular Self Breast eaxamination (it has also limitation as diagnose mostly cancer in little advanced stage) with suscpicion MRI testing annually or Mamography ,good life style having family life where Breast being used for Breast feeding,avoiding Smoking,Alcohol completely,reducing weight and avoiding high rich fatty food with regular exercise should be undertaken if GENE TESTING DONE THEN first Ovaries removal or use of drug like tamoxifen to stop estrogen inpost menopausal woman is very helpful,removal Breasts befor 50 is not recommended and absolutely not if gene not tested or no family history in three generation present.
Removal of any part of body for fear of cancer should not be accepted at all Body doesnot govern simply by gene but many environmental factors and strong psychological balnce and stong mind to fight cancer by prophylaxis of avoiding predisposing factors,good food,vitamins,minerals,good exercise and reular self and medical checkup and screening not mere removal of organs unnecessarily.