1. SUMAYYA EBRAHIM GYNAECOLOGIST PARKLANE CLINIC JOHANNESBURG
The Angelina Jolie Example : Risk Reducing Surgery for Breast and Ovarian Cancer
SUMAYYA EBRAHIM
GYNAECOLOGIST
PARKLANE CLINIC
JOHANNESBURG

2. MAY 2013

4. STATISTICS SOUTH AFRICA
NATIONAL CANCER REGISTRY
Lifetime risk of ovarian cancer 1:82
Lifetime risk of breast cancer 1:29 (2004)

5. GENETIC CANCERS BRCA 1 and BRCA2 mutations: 5-10% breast cancers
10-15% ovarian cancers
(white women in USA)

6. BRCA Tumour supressor gene
Breast cancer susceptibility gene 1 (BRCA 1)
Breast cancer susceptibility gene 2 (BRCA 2)

7. INCIDENCE OF BRCA BRCA 1 general population 1:500-1:800 BRCA 2 lower
Ashkanazi Jewish Descent 1:40

8. CANCER RISKS WITH BRCA Increased cancer risk
Breast cancer risk 5x higher
Ovarian cancer risk 3-5 x higher

9. OPTIONS WITH BRCA
SURVEILLANCE
RISK AVOIDANCE
PROPHYLACTIC SURGERY

10. SURVEILLANCE BREAST CANCER:self examination mammograms MRI
OVARIAN CANCER:clinical examinations
vaginal ultrasound
Ca125 level

11. RISK AVOIDANCE Reduction in body fat Reduction in alcohol intake
Reduced dietary fat
Increase physical activity

12. PROPYHLACTIC SURGERY BILATERAL PROPHYLACTIC MASTECTOMY
BILATERAL PROPHYLACTIC SALPINGO- OOPHORECTOMY

13. PROPHYLACTIC BILATERAL MASTECTOMY
Complete removal of both breasts
Including nipples:TOTAL MASTECTOMY
Nipple conservation:NIPPLE SPARING MASTECTOMY

14. TOTAL BILATERAL MASTECTOMY WITHOUT RECONSTRUCTION

15. TOTAL BILATERAL MASTECTOMY WITH RECONSTRUCTION IN PROGRESS

16. TOTAL BILATERAL MASTECTOMY WITH COMPLETED RECONSTRUCTION

17. 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

18. BENEFITS OF P. MASTECTOMY
BRCA1 BRCA2 MUTATIONS
Expected risk reduction of 95%
STRONG FAMILY HISTORY
Expected risk reduction of 90%

19. DRAWBACKS OF P.MASTECTOMY
Irreversible
Expensive :multiple operations
time consuming
days off work
Procedure related complications:infection
bleeding
Psychological:change in body image

20. BILATERAL PROPHYLACTIC SALPINGO-OOPHORECTOMY (BSO)
Removing
both the ovaries and
fallopian tubes

21. TECHNIQUES FOR BSO

22. CANDIDATES FOR BSO High risk women BRCA 1 and BRCA 2 mutations
Premenopausal
Older than 35
Completed families

23. BENEFITS OF BSO IN HIGH RISK WOMEN
Expected risk reduction of ovarian cancer
90%
Expected risk reduction of breast cancer
50%

24. DRAWBACKS OF BSO Permanent and irreversible
Surgical complications:infection ; haemorrhage ;intestinal obstruction
Immediate surgically induced menopause
discomforts
osteoporosis
heart disease
memory loss and dementia

25. BSO AT WHAT COST ? WITH NO HRT Higher rate of premature death,cancer,
heart disease and neurological disease
HRT?????????

26. CONCLUSION
RISK REDUCING SURGERY FOR ALL?