BRCA precautionary surgery question
Comments
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Good question; tricky answer. There is no officail "they" that I am aware of to recommend prophylactic surgery - meaning no medical organization. However, my oncologist stated emphatically that I should have bilateral mastectomy following treatment for ovarian cancer. The risks are just too high to gamble. However, it was ultimately my decision and I am completely happy with the outcome of my recent prophylactic, bilateral mastectomy and DIEP reconstruction.
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I should add that a prophylactic ooph. following breast cancer may be a much harder decision. If one is still planning to have children, that certainly has an impact on the timing of an ooph. Also, giving up one's ovaries means instant, surgical menopause, which has other health implications.
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I can't really say much about the PBM. I tested positive during my neoadjuvant chemo and since I had ILC which is hard to detect without an MRI I didn't have any problem going with a bilat when it was time to have surgery. There is no way that I wanted it to happen on the other side and go through this again. So that decision was really my call.
But all my docs have really stressed that having an oomph would be a good idea since it is so hard to detect ovarian cancer. The chemo put me in menopause so after I get through with all my tx and have had a chance to catch my breath I'm going to have that done.
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I went to see a genetic counselor after being diagnosed with BC and BRCA1+. He said he didn't care what I did with my breasts but my ovaries "are his". My sister tested positive and he told her he would call her every 6 months until she confirmed that she had her ovaries our. He also said that have the ovaries out would reduce her chance of BC because she is 40 (done with kids) and will not be exposed to estogren for as long.
Personally, I chose to have a bi-lat as I did not want to go through this again. When I told my BS that my sister was going to go with surveillance, he said that is not what he would do. He has a patient who was BRCA+ and chose surveillance and developed BC that metastasized. He felt that this was a case of Stage 4 BC that could have been avoided. He was quite sad about it.
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hi Issymom
When will you remove the ovaries? I like to remove too but I like to wait till Mid Sept., as I am still reocovering from db Mast. and reconstruction in Feb. But I am worried if waiting till Sept is risky.
What do you think?
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My doctor said with BRCA, BC usually comes first then later on in life comes the ovarian problem. I don't know how much time span it is between BC and ovary problem though. Anyone knows? Is it too risky to wait till Sept this yr for Oop?
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Newalex - I am scheduled for my hysterectomy next Friday, June 4th. I am supposed to have it done via the DaVinci Robotic device. It is supposed to be even better than the traditional laproscopic surgery. My doctor said she had on patient who went snow skiing 2 weeks post surgery. As for whether the fall is too late, I can't tell you. You could talk to you doctor about having a trans-vagina ultrasound to see if anything is going on. It is not fool-proof but it could give you some piece of mind. I had one done yesterday to ensure that I was a candidate for the daVinci and make sure that there were no surprises when they went in. I think it went OK but won't know until I hear from my surgeon today or tomorrow.
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I would say they probably do. Chances of reoccurrence are higher with the gene. I only know about the brca2 as several of my relatives have been found to have this gene. (My aunt had a re-occurrence after 30 years in opposite breast) BMX and ooph have been recommended to the younger relatives who have had BC.
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Can anyone speak to the likelihood of recurrence given BRCA positive and ER, PR, HER2 positive and negative?
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hi Issymom
Let me know how it goes and finger crossed for your Friday.
My doctor said it's ok to have the oop in Sept or even later. I plan to do it in Sept. The doctor said usually it takes 3 days - 5 days to heal at most. It's much smaller operation than mast., and reconstruction. For my mast and reconstruction, I could not move for 2 weeks and it was really painful the first month! I just want to heal from the mast and reconstruction a bit before I have another surgery.
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Dear Chinablue, what I have read on other boards is that the mastectomies and having the ovaries removed along with the tubes, can make it more difficult for a new cancer to begin, but it does not take away the chance of recurrence in other part of your body. I know that this is difficult to hear, but I'm pretty sure that this is true. I am tn as well, and BRCA2. I had my ovaries removed last August, and I'm having a double mastectomy in July so as not to get a third breast cancer diagnosis. But...I also am aware that there is still a chance that the cancer can come back in the bone, liver, and brain. With this in mind, it is recomended to eat a low fat diet with lots of vegies and fruits, and exercise at least 30 minutes a day if you can.
Take care,
Carla
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BRCA 2+ for me, found out after I developed breast cancer at what my dr's considered a young age - 42.
Also HER 2 +, will be having BMX on 6/21, only left has BC now, and ooph same day. There has been one case of Ovarian Cancer in my family, and she passed within weeks of diagnosis, as it was stage IV by the time it was caught. I can't go thru that - so out they come. And I have no kids, and am fine with that.
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Hi Chinablue,
Yes, if you have the Brca , the standard of care is to have a Bi Mx and ovaries out. I was told that I could have a lumpectomy with radiation instead of the Masectomy, as well. I am getting a Bi Mx, sential node biopsy next week and I pray that I have negative nodes. If I were to have positive nodes, I would still have to get radiation.
MRDRN
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The standard care if you have breast cancer is not to have your ovaries out. Doctors take into consideration your type of cancer. Maybe you are saying that the standard care is to have your ovaries out if you are BRCA positive and ER+/PR+?
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yes, the standard answer you would find from dedicated breast surgeons, in answer to your original question, is to have breasts and ovaries out for treatment of BRCA positive......your choice of course but your chance of getting cancer can be as high as 85% by age 50 without a BC dx....and it turned out true for me. I learned the word "previvor" , that I had the gene, and next thing I know that first MRI was positive for BC. After Bi Mx a recurrance is still possible, but down to less than 5%, Three Surgeons that I consulted with told me the same thing basically...and I am going to do it to hopefully avoid rads and chemo...but that remains to be seen.
Having my ovaries out was the first thing I did and now I am getting a Bi Mx... I will tell you that my sis who is also positive is just doing the monitoring every six months...so it is true that we all have our own journey :)She is ok knowing she is a "previvor"....and goes for every six month mri and mamm, which alternate every six months, and the insurance covers all the costs. For more information, feel free to PM me.
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