Preventive Mastectomy: Choices and Consequences

In the wake of Angelina Jolie’s stunning revelation that she had a double mastectomy done earlier this year to prevent her from acquiring breast cancer (given that her mother died of it and, recently, her aunt), the issue of preventive mastectomy has become a topic of concern for many women the world over.  To get a better understanding of the subject, we interviewed Dr. Raoul Siasoco, an obstetrician-gynecologist and acupuncturist at St. Luke’s Medical Center Quezon City.

Smart Parenting (SP): Does a preventive mastectomy really reduce the risks of breast cancer?

Dr. Raoul Siasoco (RS): It reduces the risks of breast cancer but it doesn’t eliminate them. In medicine, just like in life, there is no 100%.

SP: Can a preventive mastectomy be done here in the Philippines? Are there doctors willing to consider this?

RS: Yes, it can be done. In my first few years of practice, I’ve heard of cases that went back over ten years of people doing this. There are cases of preventive mastectomies being done here.  

(Related story: What you Need to Know about Postpartum Breast Cancer)

SP: Do the facilities for detecting breast cancer risks exist here in the Philippines? How advanced are they?  

RS: Our detecting methods are at par with the rest of the western world. We have breast imaging, mammography, breast ultrasound and even nuclear imaging of the breast where they do not need to compress the breast that much.

The thing about mammography is that it irradiates the breast tissue, and that radiation can cause cancer too.

SP: It does?  But isn’t that contradictory to what mammograms are for?

RS: An article in the November 2012 issue of the New England Journal of Medicine states that 1.3 million women were overdiagnosed and overtreated for breast cancer over the last 30 years.

Now, radiologists will say that a mammogram’s radiation is just a small dose, but that’s like putting a drop of toilet water into a glass of drinking water. Would that be considered healthy for you to drink?

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SP: So what is a safer alternative to a mammogram?

RS: Self-breast exams are effective and should be done regularly. Information dissemination is important. Women must be taught to be familiar with their personal anatomy. Breast ultrasound is also effective, though it is not at par with mammography -- at least not yet.  

So when Angelina had her breasts operated, I thought, does this mean that if you have high risks for brain tumor, you will have your brain removed?  If you have a chance of getting testicular cancer, will you have your testicles removed? Our goal should be to prevent breast cancer, but most doctors mean to halt the progression, from Stage 1 - 4. But can’t we just prevent the cancer from happening instead of having to go through all of this?

SP:  What about the gene detection test that Angelina Jolie took?  How much does that cost?  

RS: I’m not sure about the costs here, but in the U.S., Myriad Genetics holds the patent for that and they’ll do it for $400-$3000. Some centers send blood and other samples to labs abroad like Singapore for that.

SP: What should I do if the findings indicate that I have a high risk of getting breast cancer?  Are there other alternatives to a preventive mastectomy?

RS: I honestly think that Angelina wasn't given the big picture. People who would recommend such a radical treatment are usually ignorant of the alternatives. Give the patient the whole lot so she can decide. It seems to be a disservice to a patient to not have options for non-invasive methods for dealing with an illness. When it comes to women, it seems that all it takes is to remove the offending body part – hysterectomy, mastectomy, etc -- it’s so unfair to them. In a case like that, there are options that combine both Eastern and Western thought that don’t necessarily need drugs or surgery, like acupuncture and diet.

For example, if you take vitamin D and calcium, it will cut breast cancer risks by 60-70%. Broccoli, cabbage and other cruciferous vegetables have a chemical called I3C, or indole 3-carbinol which makes you less susceptible to cancer. You don’t even need to get Vitamin D from supplements – just spend a bit more time out in the sun.

If you’ll be realistic about breast cancer, it is a multi-factorial disease with lots of causes that trigger it. It’s not always about the genes; you didn’t inherit the disease, you inherited the tendency to get the disease. People should learn to prevent the illnesses, not just treat an illness once it’s already manifested.

(Related story: Chemical in Antiperspirants Found in Breast Tissues of Cancer Patients)

From the Chinese medicine point of view, masses (which lead to cancers and tumors) are the results of slow moving fluids – like blood and phlegm -- which many foods like dairy products, sugar and oil cause. No one is telling patients how we can stop forming these masses. If the goal is to prevent the masses by removing the breasts, but you continue a sedentary lifestyle with an unhealthy diet, then the masses will just form somewhere else, as the principle of Chinese medicine ultimately states.

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SP:  How soon should I have myself tested?  At what age is appropriate?

RS: These methods should be taught during high school. Women should be introduced to the concepts of female anatomy, menstruation, pap smears, cancers. The Society of Obstetricians and Gynecologists suggests that mammography should be done by age 45 and annually after that. However, self-examinations should be monthly, during your menstrual period.

SP:  How does a preventive mastectomy affect my chances of having children in the future? What will be the consequences of this procedure for me? Will I still be able to breastfeed?

RS: Technically, there is no connection between childbirth and breast removal. You can still get pregnant and even do in-vitro fertilization. There are minor effects with labor – a chemical from the brain called oxytocin can induce labor to aid women having difficulty with natural labor, and this chemical can be stimulated by massaging the nipples -- but you really don’t need the breasts for that. As for breastfeeding, that’s out of the question.

SP:  If I decide to have a preventive mastectomy, what must I do to prepare for it?

RS: Since the issue of genetics has already been factored in, genetic counseling is necessary. You should be told of all your options, including diet modification, supplementation, exercises and alternative treatments. We practitioners of both natural healing and Western medicine are against the idea of a preventive mastectomy based purely on genetic evidence alone, and instead advocate informing the patient of all the options that a patient can do to stay healthy.  

Dr. Raoul Siasoco also holds clinics at St. Luke’s Bonifacio Global City - Complementary Medicine Service and at Oasis Acupuncture Clinic.

 
Image from mastibite.com