Breast Cancer Surgery – Revisited

No Mastectomy For Breast Cancer PreventionEllen Kamhi PhD, RN, AHG, AHN-BC

I received many comments to the article I wrote entitled Breast Cancer Gene, Preventive Surgery?

Some comments were against the point of view I espoused, which was to get tested regularly, and seriously incorporate lifestyle measures, such as exercise, natural food and stress reduction techniques that are proven to decrease the risk of activating cancer genes.   I rejoice that readers take the time to share their views, even if we do not agree. Below are my comments to one of the dissenting responders.

Thank you for your comment. Of course mastectomy reduces chances of getting breast cancer, since the patient no longer has breasts! I am actually a strong proponent of surgery for cancer treatment, and always support my patients in choosing to have the least invasive surgery possible if they are diagnosed with any form of cancer. By the way, I am not judging Angelina, or anyone else who decides, after reviewing all data, to use surgery as a path to optimum wellness and disease prevention.

In terms of all medical procedures, as health professionals, I believe the best course of action is to access the overall risk benefit ratio. If we look at the risks of surgery in general, we find the following:

In the United States, figures suggest estimated deaths per year:

  • 12,000 due to unnecessary surgery
  • 7,000 due to medication errors in hospitals
  • 20,000 due to other errors in hospitals
  • 80,000 due to nosocomial infections in hospitals
  • 106,000 due to non-error, negative effects of drugs

Iatrogenesis may cause 225,000 deaths per year in the United States (excluding recognizable error.) Starfield B (July 2000). “Is US health really the best in the world?” (PDF). JAMA 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID 10904513.

In addition, Breast Surgery has additional risk factors. According to Anne Rosenberg, MD, Breast Surgeon at Thomas Jefferson University Hospital:

Question: What are the risks associated with surgery?

Answer: The risks associated with surgery or breast surgery include all those things that can happen to you when you have any kind of a surgical procedure, besides those that are specific to operating on the breast. So while people can have infections, bleeding, trouble with the anesthesia; some women have some nausea after the anesthesia. Those are complications that you might have just from any surgical procedure. The complications relative to breast surgery have to do with the fact that you may have some distortion in the breast if a big enough piece of tissue is removed. You may have some numbness. If you operate on the armpit you may have some issues with swelling of the arm, which is what we call lymphedema, or some numbness in the underarm area.

The following is from the American Cancer Society Website:

Possible complications during surgery may be caused by the surgery itself, the drugs used (anesthesia), or an underlying disease. Generally speaking, the more complex the surgery is the greater the risk.

Minor operations and tissue samples (biopsies) usually pose less risk than major surgery. Pain at the site of the cut (incision) is the most common problem. Infections at the site and reactions to the drugs used to numb the area being treated (local anesthesia) are also possible.

Complications in major surgical procedures are not common, but can include:

  • Bleeding during surgery that may cause you to need blood transfusions. There is a risk of certain problems with transfusions, some of them serious. Doctors try to minimize this risk by checking your blood counts beforehand and being careful when working near blood vessels. Still, some operations involve a certain amount of controlled blood loss. If you have concerns about needing a blood transfusion, talk to your doctor before surgery. You may be able to save (bank) some of your own blood in the weeks before surgery so it can be given back to you during the operation if needed. This is called autologous transfusion (aw-tahl-uh-gus trans-few-zhun). For more information, see Blood Product Donation and Transfusion, which you can read online or get by calling our toll-free number.
  • Damage to internal organs and blood vessels during surgery. Again, doctors are careful to allow as little damage as possible.
  • Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures. Your doctors will watch your heart rate, breathing rate, blood pressure, and other signs throughout the procedure to look for this.
  • Problems with other organs, such as the lungs, heart, or kidneys. These problems are very rare but can happen and can be life-threatening. They are more likely to happen to people who already have problems with these organs. This is why doctors get a complete medical history to look for possible risks before an operation is done.

After surgery

Some problems after surgery are fairly common, but are not usually life-threatening.

  • Pain is probably the most common side effect. Almost everyone has some level of pain after surgery. Some pain is normal, but it should not be allowed to slow down your recovery. There are many ways to deal with surgical pain. Medicines for pain range from aspirin and acetaminophen (Tylenol®) to stronger drugs, like codeine and morphine.
  • Infection at the site of the wound is another possible problem. Doctors take great care to reduce this risk by cleaning the area and keeping the area around it sterile, but infections do happen. Antibiotics, either as a pill or given through a vein in your arm (IV), are able to treat most infections.

Now lets investigate some of the data supporting a nutritional and lifestyle approach to reducing cancer risk.

Pharm Res. 2008 September; 25(9): 2097–2116. Published online 2008 July 15. doi:  10.1007/s11095-008-9661-9.PMCID: PMC2515569

Cancer is a Preventable Disease that Requires Major Lifestyle Changes

“After sequencing his own genome, pioneer genomic researcher Craig Venter remarked at a leadership for the twenty-first century conference, “Human biology is actually far more complicated than we imagine. Everybody talks about the genes that they received from their mother and father, for this trait or the other. But in reality, those genes have very little impact on life outcomes. Our biology is way too complicated for that and deals with hundreds of thousands of independent factors. Genes are absolutely not our fate. They can give us useful information about the increased risk of a disease, but in most cases they will not determine the actual cause of the disease, or the actual incidence of somebody getting it. Most biology will come from the complex interaction of all the proteins and cells working with environmental factors, not driven directly by the genetic code” (”

Also, if you opened the links within my original article, you will see data supporting scientific evidence that specific healthy eating patterns offer high levels of protection against the development of Breast Cancer in people who have a genetic mutation in BRCA1 and BRCA 2. In one study, entitled Diet quality and BRCA-associated breast cancer risk, (Breast Cancer Res Treat. 2007 Jul;103(3):361-9. Epub 2006 Oct 25.), the researchers concluded “dietary guidelines reflected by the DQI-R(Diet Quality Index Revised) and CHEI ( Canadian Healthy Eating Index) may constitute preventive strategies for reducing BRCA-associated BC risk.”

There is , of course, much more to consider. My point is, that if someone knows they have an increased risk to develop any kind of cancer, the most prudent action is to eat healthy foods, reduce exposure to environmental toxins, and , or course, have regular medical screenings. At the first sign of a problem, of course more aggressive interventions are warranted, but to use surgery as a preventive is only one extremely radical option.

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