Should women embrace preventive mastectomy

Leading American actress Angelina Jolie recently came out in the open about her decision to have both her breasts removed to reduce her chances of getting breast cancer. Is this the way all high-risk women should go? SYLVIA WAKHISI explores

Last week, award-winning actress Angelina Jolie came out in the open about her bold decision to have double mastectomy (removal of both breasts) to reduce her chances of getting breast cancer, which her mother died of. Her move was hailed by many, especially women around the world.

Her decision to come out in the open bravely helped inform women with a history of breast cancer in their families about the need to be pro-active with their health — by seeking out testing and counselling.

For a woman whose career is tied to her appearance, her willingness to talk about her decision provides support to women and their partners who may face a similar difficult choice.

The actress decided to undergo the procedure after learning that she carries a mutated version of the BRCA1 (breast cancer susceptibility) gene, which greatly increases a woman’s risk of developing breast cancer.

“I am writing about my preventive double mastectomy now because I hope other women can benefit from my experience,” said the actress in her article.

“I decided to be proactive and to minimise the risk as much I could,” she wrote. Her partner, Brad Pitt, praised her choice as ‘absolutely heroic’.

Angelina’s goal in letting the world know about this was to educate women out there about the pre-emptive actions they can take with finding out their susceptibility to cancer. So what does this decision mean to women who face such a threat?

Means a lot

For Adelle Onyango, a presenter with a local radio station who lost her mother, Mary Onyango, to breast cancer last year, this news means a lot.

Adelle knows that she holds much greater risk of developing the disease.

“I am aware of the risk I’m subjected to, and if what Angelina Jolie did is 100 per cent medically proven by my doctors that it will work, then I would not think twice about having a double mastectomy,” says Adelle.

“Having breasts is something women attach themselves to because it is one of those things that describe their femininity; but if having them removed is what will save my life, then I will be more than ready to do it,” she adds.

To be on the safe side, Adelle goes for monthly breast exams — both self and clinical — and whenever she feels anything unusual in her boobies, just to ascertain her health status.

“So far, my doctors have assured me there is no cause for alarm and I’m happy and living my life to the fullest,” she says.

Katheke Mbithi, a breast cancer survivor and the honorary secretary of the Kenya Cancer Association says Angelina’s decision is brave.

“What the actress has done is commendable. Personally, if I was sure of the results, this is something I would advocate for my two daughters because I know they have a high risk of getting the disease,” says Katheke.

Katheke was diagnosed with breast cancer almost eight years ago and she is still coping with the disease.

She says thanks to preventive options available, her daughters and other women out there need not go through what she and others went through.

Better options

“When I was diagnosed with breast cancer, I did not know much about it. I had no relative or friend with breast cancer. But now there is a lot of awareness and women can arrest the problem before it gets out of hand,” she says.

“When the diagnosis was made, my doctor referred me to the late Mary Onyango, who not only encouraged and empowered me, but also offered me a lot of reading materials on breast cancer. She walked with me through the journey.”

Katheke says a lot of awareness is still needed on breast cancer.

“There are a lot of myths concerning cancer. The sad bit is that women in the rural areas have no clue about these prevention options, and are in an information desert,” she says.

As a way of empowering women about cancer, Katheke talks to groups of women, enlightening them on the importance of having breast exams every month and a pap smear for cervical cancer every year.

Award-winning musician Wahu Kagwi, says if she was at risk, she would go the Angelina way — double mastectomy.

“I do not want to die early and for the sake of my family, if I had the means, I would go for genetic testing just to rule out whether I have a gene that could increase the chance of me developing cancer,” says Wahu.

“With the good healthcare offered in the West, people can afford to go for such tests. The Government needs to do something when it comes to our healthcare system, which is too overpriced such that many people with cancer end up dying simply because they cannot afford the cost of treatment,” she adds.

Her sentiments are echoed by Katheke: “As a country, we still have a long way to go as far as cancer is concerned. Angelina was able to go for genetic testing because she could not only afford it, but it was also easily available,” she says.

 Habida Moloney, another Kenyan songstress, however, thinks differently about the idea of having a double mastectomy.

“You cannot pre-empt what God has planned for your life. I would not dare cut off my breasts, especially now that am a married woman,” says Habida.

Opinion aside, is this the pro-active way all women who have a high risk of getting breast cancer should go — have a double mastectomy? Experts have varied opinion on this move.

Dr Catherine Nyongesa an oncologist based in Nairobi says what the actress has done is commendable and can help save lives.

“This is a good approach to women who have first degree relatives, that is, mother or aunty have cancer like in Angelina’s case. But it  is important to note that not all cancers are associated with the gene,” she expounds.

Dr Alfred Murage, a consultant obstetrician and gynaecologist at Aga Khan University Hospital says Angelina appears to have had a rare gene (BRCA), which predisposes her to early onset breast cancer (and ovarian cancer).

Rare gene

Murage says the specific gene is rare (common in Ashkenazi Jews) in our population.”

 “Angelina’s choice of double mastectomy is reasonable, bringing her risk of future cancer to very low levels (but not to zero). Such an approach would be very rare to an ordinary Kenyan woman,” the doctor explains.

Kenya Cancer Association vice- chairman and  manager of the cancer programme at the Aga Khan University David Makumi concurs with Murage that not every woman should embrace preventive mastectomy as a way of dealing with the risk of getting breast cancer.

“Such an approach should only be considered by those who are specifically genetically pre-disposed to faulty genes that place them at a higher risk of getting breast cancer. They should also have undergone the genetic testing procedure,” says Makumi.

 He adds that even if the faulty genes are found to be present, other approaches could be taken first, which include regular surveillance through breast exams and frequent magnetic resonance imaging — a type of scan used to diagnose health conditions that affect organs, tissue and bone.