‘An­gelina op’ is given to women it can’t help

... but here’s why the NHS won’t test me for it as I just ‘wait my turn’

The Mail on Sunday - - The Great Election Flasco - By Jane Palmer and Stephen Adams

SUR­GEONS are en­cour­ag­ing women with breast cancer to have dou­ble mas­tec­tomies that do lit­tle or noth­ing to im­prove sur­vival chances, a lead­ing doc­tor has warned.

Dr Fiona MacNeill, a sur­geon at Lon­don’s Royal Mars­den Hos­pi­tal, said medics were ‘driv­ing the re­moval’ of the sec­ond – healthy – breast some­times just to give pa­tients ‘peace of mind’.

The warn­ing comes af­ter a US study showed the opinion of a pa­tient’s sur­geon has a strong ef­fect on whether she has a dou­ble mas­tec­tomy af­ter be­ing di­ag­nosed with cancer in a sin­gle breast. Among pa­tients of sur­geons who most f a voured t he op­er­a­tion – of­fi­cially called a con­tralat­eral risk re­duc­ing mas­tec­tomy ( CRRM) – 34 per cent went ahead. But among pa­tients of sur­geons most strongly against, only four per cent had i t, ac­cord­ing to the re­search pub­lished in the jour­nal JAMA Surgery. Dr MacNeill said pre­vi­ous re­search has shown that, for women di­ag­nosed with cancer i n one breast, a dou­ble mas­tec­tomy ‘does not sig­nif­i­cantly re­duce risk or im­prove sur­vival’.

That is be­cause the risk of cancer oc­cur­ring in the other breast is low. By con­trast, ‘their big­ger risk is their orig­i­nal cancer re­turn­ing else­where in their body’.

Dr MacNeill said: ‘So many of these ladies are hav­ing both their breasts re­moved think­ing it’s go­ing to be a longer- term ben­e­fit for them but the re­al­ity is it’s not.

‘They’re prob­a­bly putting them­selves at more harm in terms of ex­ces­sive surgery and the com­pli­ca­tions from surgery.’

She added: ‘One of my con­cerns is that it’s sur­geons them­selves who are driv­ing this re­moval of healthy breast.’ The rea­sons most fre­quently cited by sur­geons for per­form­ing this type of dou­ble mas­tec­tomy i ncluded to ‘ give pa­tients peace of mind’ and to ‘avoid pa­tient con­flict’.

Women them­selves could also want dou­ble mas­tec­tomies to achieve bet­ter sym­me­try af­ter surgery, which is eas­ier to achieve with two iden­ti­cal im­plants rather than try­ing to match a re­con­structed breast to a nat­u­ral one.

But Dr MacNeill warned re­con- structed breasts lacked sen­sa­tion, and that hav­ing a dou­ble mas­tec­tomy was likely to ‘im­pact on your fem­i­nin­ity, your im­age and your ul­ti­mate sex­u­al­ity’.

The num­ber of dou­ble mas­tec­tomies car­ried out in Bri­tain has surged since ac­tress An­gelina Jolie, now 42, had the pro­ce­dure in 2013. NHS fig­ures show a leap from 234 in 2010 to 484 in 2016.

How­ever, Jolie had the op­er­a­tion to stop cancer de­vel­op­ing in the first place, rather than to stop it re­cur­ring. She took the de­ci­sion af­ter find­ing out she car­ried the BRCA1 gene, which sub­stan­tially raises the risk of both breast and ovar­ian cancer.

Re­mov­ing healthy breast ‘does lit­tle to re­duce risk’

HAR­ROW­ING, ex­hil­a­rat­ing, over­whelm­ing. Life as a ju­nior doc­tor was all of those things. But of all the ter­ri­fy­ing new ex­pe­ri­ences I had to deal with in my first year work­ing in a hos­pi­tal, there was one evening that eas­ily trumps the rest.

It was when my fa­ther rang me, via the hos­pi­tal switch­board, to tell me my mother had been di­ag­nosed with breast cancer.

Stand­ing in the of­fice on the med­i­cal ward where I work­ing, it felt un­be­liev­able and ter­ri­fy­ing, es­pe­cially so when I was busy try­ing to learn how to deal with the pain and ill­ness of oth­ers. But the news was also alarm­ingly ex­pected. You see, there has al­ways been a lot of breast cancer in my fam­ily.

When I was four, my mother’s mother, my grand­mother, died of breast cancer just as her mother, my great-grand­mother, had done years ear­lier. Be­fore I even knew what breast cancer was, I knew it was some­thing to be fear­ful of.

Mum was al­ways dili­gent at get­ting her­self checked, above and be­yond the usual screen­ing pro­gramme for women. So al­though I was shaken when Mum was di­ag­nosed, it was like the bad news we had all been wait­ing for.

That was in 2002, the year she turned 60. I re­mem­ber her con­sul­tant calmly ex­plain­ing the op­tions to us, just as I had learned to do: surgery and ra­dio­ther­apy for sure, and chemo­ther­apy as an ex­tra.

‘ What would be the ben­e­fit of that?’ I asked the con­sul­tant, a breast sur­geon who had taught me only a year or two ear­lier. ‘Hav­ing chemo will bring down the like­li­hood of re­cur­rence from 13 per cent to 11 per cent, so not a huge amount,’ came the an­swer.

Many women with early- stage breast cancer choose not to have chemo as the down­sides, in terms of the side ef­fects, out­weigh the small ben­e­fit.

‘We’ll take the chemo too please,’ I as­serted with typ­i­cal ju­nior-doc­tor gusto, as if I’d just been of­fered an up­sell at a check­out.

That was the fear of a daugh­ter talk­ing, rather than the lev­el­head­ed­ness of a doc­tor.

Mum went through surgery, six months of chemo­ther­apy com­plete with sick­ness, lethargy, hair loss and ev­ery­thing else, and then em­barked on ra­dio­ther­apy.

She left the hos­pi­tal, the year af­ter di­ag­no­sis, bat­tered and bruised but cured and re­mains so to this day, aged 75. By pro­to­col, hav­ing been well for more than ten years, Mum doesn’t even war­rant fol­low-up any more, but breast cancer is still this con­stant worry, par­tic­u­larly for me.

Be­cause de­spite what I see very clearly – a sig­nif­i­cant ten­dency to breast cancer among the women in my fam­ily – it is not recog­nised med­i­cally as a sig­nif­i­cant fam­ily his­tory that war­rants any kind of spe­cial screen­ing or med­i­cal at­ten­tion for fam­ily mem­bers.

Two years ago, my aunt – my mum’s only sib­ling – was di­ag­nosed with breast cancer, al­though she was also suc­cess­fully treated. So now I have had a great- grand­mother, a grand­mother, a mum and my only ma­ter­nal aunt with breast cancer.

I feel like the fourth gen­er­a­tion wait­ing for my turn. And the fifth gen­er­a­tion will be my daugh­ter Lot­tie, who is 13. But we are not con­sid­ered high-risk. It’ ll be an­other decade be­fore I’m in­vited for my first mam­mo­gram.

Women who are known to have hered­i­tary breast cancer are given scans an­nu­ally, at least. And as a doc­tor I know why I’m not of­fered this. The pur­pose of screen­ing is to pick up dis­ease at a very early stage, so it can be bet­ter treated and is less likely to be fa­tal. The NHS only of­fers mass test­ing to symp­tom­less, seem­ingly healthy peo­ple, if it’s been proved to save lives. There is no such ev­i­dence that screen­ing all women like me would pre­vent any deaths.

AS A doc­tor, I know all this. But I find it hard to ac­cept as a pa­tient and as a mother that there is no clear plan of ac­tion other than wait­ing for the next di­ag­no­sis.

Spe­cial­ists de­scribe our cancer story as a fa­mil­ial clus­ter. The most com­mon hered­i­tary breast can­cers are trig­gered by what are known as BRCA gene mu­ta­tions, which cause ag­gres­sive cancer at a young age. Tests have shown we are neg­a­tive for these. But cancer is com­mon: if one woman in eight gets breast cancer, it is not be­yond the realms of prob­a­bil­ity that a fam­ily could be af­fected as we have just by chance. And cer­tainly so in an Ashke­nazi Jewish fam­ily like mine, a racial group where cancer tends to be more com­mon any­way.

But there are other po­ten­tial rea­sons that can also ex­plain it: fam­i­lies and races share not only genes but also life­styles and en­vi­ron­ments. So you get the dis­eases your fam­ily do be­cause you do the same things and live the same way, not be­cause it is writ­ten in your DNA.

This leaves me with a fam­ily his­tory that is not sig­nif­i­cant enough to jus­tify a med­i­cal plan of ac­tion. But it is sig­nif­i­cant enough to cause con­tin­ual anx­i­ety.

The para­dox­i­cal ben­e­fit of my aunt’s re­cent di­ag­no­sis ac­tu­ally means that I am con­sid­ered very slightly higher risk than be­fore, be­cause I now have three first or sec­ond- de­gree rel­a­tives with breast cancer.

This has given me ac­cess to an NHS clinic for women who have a

higher-than-nor­mal risk of breast cancer. I’ll be seen later this month and I hope fol­lowed up more closely: some­thing I have never been of­fered be­fore.

And as I can’t ig­nore my fam­ily his­tory, all I can do is try to mit­i­gate my own life­style risks.

Risk fac­tors for breast cancer are well doc­u­mented and well re­searched. Next week, ex­clu­sively in The Mail on Sun­day, you will find my 32-page How To Cut Your Risk Of Cancer guide.

In it, I speak to some of Bri­tain’s lead­ing ex­perts to bring you the lat­est, ev­i­dence-based ad­vice on un­der­stand­ing and hope­fully min­imis­ing your per­sonal risks.

The first in­stal­ment will tackle breast and prostate cancer, the two most com­mon can­cers in men and women. The fol­low­ing week, we will look at bowel cancer. I feel like I’m do­ing my best by mak­ing sure I know what I can do to re­duce t he odds of de­vel­op­ing breast cancer and I want to help you, the read­ers, to do the same. But be­ing proac­tive goes some way to dis­si­pat­ing my anx­i­ety. My al­co­hol con­sump­tion is min­i­mal as drink­ing is known to be as­so­ci­ated with breast cancer. I also try to main­tain a reg­u­lar ex­er­cise rou­tine. This does not come nat­u­rally to me at all, but whether it’s spin­ning or run­ning, I throw my­self into ex­er­cise rou­tines as I know how ben­e­fi­cial it is against cancer risk. And the no­tion of ex­er­cise de­spite a lack of sport­ing ap­ti­tude is cur­rently be­ing in­stilled in my daugh­ter, for all the health ben­e­fits it will con­fer to her too. To fur­ther pro­tect my­self even / as a young woman, I never took the Pill for more than a few months as this is as­so­ci­ated with breast cancer, and have al­ways had a good rou­tine of be­ing aware of my own body and be­ing vig­i­lant to any changes./ So for now that is my plan, and this is the strat­egy and knowl­edge I will give my daugh­ter. I hope that by shar­ing my story, and read­ing my guide, you too will be in­spired to make some changes that will help pro­tect you, and your fam­ily’s health.

DAN­GER GENE: An­gelina Jolie had dou­ble mas­tec­tomy

FAM­ILY AF­FAIR: El­lie with daugh­ter Lot­tie. Be­low: El­lie aged seven with her mother, who was cured

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