SUMAYYA EBRAHIM GYNAECOLOGIST

PARKLANE CLINIC JOHANNESBURG

NATIONAL CANCER REGISTRY

Lifetime risk of ovarian cancer 1:82

Lifetime risk of breast cancer 1:29 (2004)

BRCA 1 and BRCA2 mutations:

5-10% breast cancers

10-15% ovarian cancers

(white women in USA)

Tumour supressor gene

Breast cancer susceptibility gene 1 (BRCA 1)

Breast cancer susceptibility gene 2 (BRCA 2)

BRCA 1 general population 1:500-1:800

BRCA 2 lower

Ashkanazi Jewish Descent 1:40

Increased cancer risk

Breast cancer risk 5x higher

Ovarian cancer risk 3-5 x higher

SURVEILLANCE

RISK AVOIDANCE

PROPHYLACTIC SURGERY

BREAST CANCER:self examination mammograms MRI

OVARIAN CANCER:clinical examinations vaginal ultrasound Ca125 level

Reduction in body fat

Reduction in alcohol intake

Reduced dietary fat

Increase physical activity

BILATERAL PROPHYLACTIC MASTECTOMY

BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY

Complete removal of both breasts

Including nipples:TOTAL MASTECTOMY

Nipple conservation:NIPPLE SPARING MASTECTOMY

Known BRCA1 and BRCA2 mutations

Strong family history without BRCA mutations

Lobular carcinoma in situ(LCIS)+family history

Radiation to chest wall before 30 years of age

Cancer in one breast

BRCA1 BRCA2 MUTATIONS Expected risk reduction of 95%

STRONG FAMILY HISTORY Expected risk reduction of 90%

Irreversible

Expensive :multiple operations time consuming days off work

Procedure related complications:infection bleeding

Psychological:change in body image

Removing both the ovaries and fallopian tubes

High risk women

BRCA 1 and BRCA 2 mutations

Premenopausal

Older than 35

Completed families

IN HIGH RISK WOMEN

Expected risk reduction of ovarian cancer 90%

Expected risk reduction of breast cancer

50%

Permanent and irreversible

Surgical complications:infection ; haemorrhage ;intestinal obstruction

Immediate surgically induced menopause discomforts osteoporosis heart disease memory loss and dementia

WITH NO HRT Higher rate of premature death,cancer, heart disease and neurological disease

HRT?????????

RISK REDUCING SURGERY FOR ALL?