Few in Singapore opt to remove both breasts, ovaries

FEW women in Singapore will have both their breasts and ovaries removed - even when they know they have an extremely high risk of getting cancer, doctors here say.

However, a handful do take that radical step.

Dr Lee Soo Chin, a senior cancer specialist at the National University Cancer Institute, Singapore, said doctors would routinely suggest that patients with the BRCA gene mutation have their breasts and ovaries removed.

About one in 3,000 to 5,000 men and women have the BRCA mutation. The BRCA1 and BRCA2 genes suppress tumours but a mutation prevents them from doing their job.

Out of 10 women with a BRCA mutation, at least eight will get breast cancer and five will get ovarian cancer in their lifetime.

Dr Lee added: "In our experience, approximately 20 to 30 per cent of these high-risk individuals accept the recommendations. Patients tend to be more willing to undergo removal of ovaries than mastectomy."

Dr Ong Kong Wee, a senior cancer surgeon, said the National Cancer Centre Singapore has seen 30 cases of preventive breast removal in the past decade, with triple the number opting for it today compared with 10 years ago.

However, only one of the 30 women had the gene mutation. The rest were also considered to be at a high risk of breast cancer.

Women who have two or more close family members with breast cancer are considered a high risk.

If the relatives got their cancer earlier in life, the chances are high that they have inherited BRCA gene mutation, said Dr Esther Chuwa, a breast surgeon who operates at Gleneagles Hospital.

Dr Chuwa has also worked in the United States and Britain where she said women are far more likely to go for surgery rather than risk getting cancer and suffering through the treatment.

She herself would certainly opt for surgery if she had the BRCA mutation. She said: "I would do it rather than have cancer and get treated for it. I'd rather be in charge."

Dr Chuwa added that cancers in women with a BRCA mutation usually grow rapidly and can spread beyond the breast within a year.

Men with the BRCA mutation are also at higher risk of getting breast cancer, she said, and can pass on the mutation to their children.

In the private sector, mastectomy and reconstruction of both breasts costs about $50,000, said Dr Chuwa, and requires both a general and a plastic surgeon. The test to check if a woman has BRCA mutation costs about $6,000.

Dr Tay Eng Hseon, a private specialist in women's cancers, said that even following mastectomy, the woman still has a small risk of getting breast cancer. She will also still be at risk of cancer of the peritoneum - the lining of the abdomen - as that too is linked to the same mutation. The incidence of such cancer is low.

But he, too, would recommend surgery. He said: "Intense screening has not been proven to be definitely effective to prevent a cancer or reduce the mortality, so it is reasonable to consider these surgical options."

Plastic surgeon Walter Tan of Raffles Hospital said advances in breast reconstruction techniques ensure that women who undergo mastectomies "will still have aesthetically satisfactory breasts" following their breast removal.

Dr Hong Ga Sze, head of the breast department at KK Women's and Children's Hospital, said such gene mutations are rare, "so such preventive mastectomy is also rare".

He added that women here should not confuse preventive breast removal for people at high risk as referring to women who have had breast cancer in one breast.

Dr Hong said: "In patients who already have breast cancer, there is no evidence that removal of the opposite breast will confer a better survival."

salma@sph.com.sg

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