I think I am becoming Cliff Clavin. You know, that annoying person that keeps bringing up trivia: A peanut isn’t actually a nut. (It’s a legume aka bean.) A tomato isn’t actually a vegetable. (It’s a fruit.)
A prophylactic mastectomy isn’t actually a breast cancer cure. It does significantly reduces breast cancer risk, but it doesn’t guarantee that you’ll never develop the disease.
“Prophylactic mastectomy is highly effective,” reports Karen Kaplan in the LA Times Booster Shots blog. “Studies show it reduces the risk of developing breast cancer by 90 percent in moderate- and high-risk women.”
Comedian Wanda Sykes recently revealed she had a double mastectomy after a DCIS diagnosis in her left breast. Noting that her family has a history of breast cancer, Sykes said: “I had both breasts removed … because now I have zero chance of having breast cancer.”
In 2008, actress Christina Applegate declared herself cured after her prophylactic BMX.
A a 90% percent risk reduction is nothing to sneeze at but it isn’t exactly the same as an iron-clad guarantee. That’s because some breast tissue remains behind even when the breasts are removed.
“Bilateral mastectomies as a treatment for breast cancer are not a cure,” Dr. Len Lichtenfeld wrote in 2008. “They are the best strategy we have to reduce the risk of another breast cancer in the opposite breast, but they don’t remove risk completely.”
“Even in the hands of the best surgeons, bilateral mastectomies in a BRCA positive woman who has not had breast cancer reduces the risk of a new primary breast cancer to about 10%. That’s because even in the best surgical hands, there is still some breast tissue left behind after these procedures.”
–Dr Len, August 30, 2008, “Did Christina Applegate Send The Right Message?”
Many African American women are reluctant to talk about their breast cancer. As Sykes joked:”I was like, I don’t know, should I talk about it or what? How many things could I have? I’m Black, then Lesbian. I can’t be the poster child for everything.”
So I applaud her for going public with her diagnosis. We don’t know the exact details of her case and of course each person’s situation is different. But as Dr. Len wrote following Christina Applegate’s 2008 news: “There is something in our national psyche that makes the diagnosis of cancer in a celebrity something more important…for many of us their disease becomes our disease.”
Sykes alluded to her family history but didn’t reveal if she carries the BRCA1 mutation as Applegate does. Most cancer just happens–it’s sporadic vs. heriditary. The majority of people who develop breast cancer didn’t inherit an abnormal breast cancer gene and have no family history.
But about five percent of people have a genetic mutation which predisposes them to cancer. Two abnormal genes BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) are associated with a higher lifetime risk of developing breast and/or ovarian cancer.
“[Applegate] selected bilateral mastectomies, which is a recommended treatment for women with BRCA1-related breast cancer,” Dr. Len observed. ” That’s because these cancers have a high likelihood to be bilateral at some time, and the mastectomy reduces the risk of additional breast cancer significantly.”
Dr. Len continued:
“We don’t know if Ms. Applegate’s breast cancer is cured. We hope and pray it is—as we do for every woman who is diagnosed with this disease.
For most women with breast cancer, we know that the risk of recurrence stays with them throughout their lives. Recent research reemphasized that point. Women with breast cancer live with that reality every day of their lives.
We do applaud the awareness Ms. Applegate has brought to the issue of understanding your risk of breast cancer, and getting screened appropriately. That means for women at high risk getting an annual MRI and mammogram, as recommended by recently released American Cancer Society guidelines…
Our progress in the treatment of breast cancer—and we have made a lot of progress–doesn’t come without the need to make certain that women are accurately informed about their breast cancer and their treatment options.
Giving false hope has been a hallmark of much of our past experience with cancer.”