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SUMAYYA EBRAHIM GYNAECOLOGIST PARKLANE CLINIC JOHANNESBURG
The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer SUMAYYA EBRAHIM GYNAECOLOGIST PARKLANE CLINIC JOHANNESBURG
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MAY 2013
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STATISTICS SOUTH AFRICA
NATIONAL CANCER REGISTRY Lifetime risk of ovarian cancer 1:82 Lifetime risk of breast cancer 1:29 (2004)
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GENETIC CANCERS BRCA 1 and BRCA2 mutations: 5-10% breast cancers
10-15% ovarian cancers (white women in USA)
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BRCA Tumour supressor gene
Breast cancer susceptibility gene 1 (BRCA 1) Breast cancer susceptibility gene 2 (BRCA 2)
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INCIDENCE OF BRCA BRCA 1 general population 1:500-1:800 BRCA 2 lower
Ashkanazi Jewish Descent 1:40
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CANCER RISKS WITH BRCA Increased cancer risk
Breast cancer risk 5x higher Ovarian cancer risk 3-5 x higher
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OPTIONS WITH BRCA SURVEILLANCE RISK AVOIDANCE PROPHYLACTIC SURGERY
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SURVEILLANCE BREAST CANCER:self examination mammograms MRI
OVARIAN CANCER:clinical examinations vaginal ultrasound Ca125 level
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RISK AVOIDANCE Reduction in body fat Reduction in alcohol intake
Reduced dietary fat Increase physical activity
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PROPYHLACTIC SURGERY BILATERAL PROPHYLACTIC MASTECTOMY
BILATERAL PROPHYLACTIC SALPINGO- OOPHORECTOMY
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PROPHYLACTIC BILATERAL MASTECTOMY
Complete removal of both breasts Including nipples:TOTAL MASTECTOMY Nipple conservation:NIPPLE SPARING MASTECTOMY
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TOTAL BILATERAL MASTECTOMY WITHOUT RECONSTRUCTION
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TOTAL BILATERAL MASTECTOMY WITH RECONSTRUCTION IN PROGRESS
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TOTAL BILATERAL MASTECTOMY WITH COMPLETED RECONSTRUCTION
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CANDIDATES FOR P.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
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BENEFITS OF P. MASTECTOMY
BRCA1 BRCA2 MUTATIONS Expected risk reduction of 95% STRONG FAMILY HISTORY Expected risk reduction of 90%
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DRAWBACKS OF P.MASTECTOMY
Irreversible Expensive :multiple operations time consuming days off work Procedure related complications:infection bleeding Psychological:change in body image
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BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY (BSO)
Removing both the ovaries and fallopian tubes
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TECHNIQUES FOR BSO
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CANDIDATES FOR BSO High risk women BRCA 1 and BRCA 2 mutations
Premenopausal Older than 35 Completed families
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BENEFITS OF BSO IN HIGH RISK WOMEN
Expected risk reduction of ovarian cancer 90% Expected risk reduction of breast cancer 50%
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DRAWBACKS OF BSO Permanent and irreversible
Surgical complications:infection ; haemorrhage ;intestinal obstruction Immediate surgically induced menopause discomforts osteoporosis heart disease memory loss and dementia
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BSO AT WHAT COST ? WITH NO HRT Higher rate of premature death,cancer,
heart disease and neurological disease HRT?????????
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CONCLUSION RISK REDUCING SURGERY FOR ALL?
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