Optimal treatment of breast cancer in BRCA gene mutations

Brief History

Mrs. Sarika Navale (name changed) is a 33 year old, lady working as a nurse in a reputed hospital. She is married for 10 years and has two children, the youngest child is 4 years of age. She came to us with a lump in the left armpit over a month.

An excisional biopsy was done and it was diagnosed to be a lymph node with cancer that has spread from breast. Since there were no palpable lesions in the left breast and mammogram did not show any abnormality either, breast MRI was done. MRI of the breast showed a 2 cm lump near the nipple.

The immunohistochemistry done on the biopsy specimen showed it was a triple negative breast cancer (No ER, PR or HER 2neu receptors). A PET scan was done, which ruled out metastases (distant spread of the disease). In view of lymph node positivity, triple negative status, she was started on neoadjuvant (before surgery) chemotherapy and referred for genetic counseling.

Her genetic testing came positive for BRCA 1 mutation. Due to this mutation, she was at high risk for developing breast cancer in the opposite (right) breast and ovaries in future.

After Mrs. Sarika finished her chemotherapy, these risks were discussed in detail with her. She was advised to consider the removal of both breasts and both ovaries to prevent the appearance of new cancers in those organs, in future.

Patient’s Concern

Patient was concerned about her appearance after removal of both the breasts. She was also worried about the impact of removal of both ovaries on her health.

Treatments We Offered

We planned,

  • Bilateral Skin-Sparing Mastectomy (removal of the entire breast with nipple while preserving the skin covering the breast) with Axillary Clearance (removal of the nodes in the arm pit where the breast cancer usually spreads) for the affected left breast which had cancer
  • A Simple Skin Sparing Mastectomy ( removal of the entire breast along with nipple) for the normal right breast
  • Bilateral Saphingo-Oophorectomy (removal of both ovaries and tubes).
  • We also planned reconstruction of both her breasts using her own abdominal fat. This is called as a DIEP Flap (deep inferior epigastric perforator flap). The abdominal fat along with overlying skin and blood vessel is used to reconstruct a new breast.

Results

Patient underwent surgery, received breast reconstruction for both sides.

Her post-operative recovery was uneventful and she was discharged after 7 days. Patient took additional chemotherapy. She also received radiation to the left side.

After the completion of the treatment, she is back to work at her hospital. She has the freedom to do all her routine activities which she used to do earlier.

With breast reconstruction, she does not get reminded of the cancer she faced whenever she has to choose what kind of clothes to wear.

Core Message

Diagnosing BRCA mutations in breast cancer patients is important to offer optimal treatment. Breast cancer patients with BRCA gene mutations have a high risk of developing cancer in the opposite breast and ovaries.

Addressing this future risk is also essential while treating the present breast cancer. This is usually done by removal of the normal breast and normal ovaries at the time of surgery for breast cancer.

Removal of both breasts is a devastating experience for a lady. Breast reconstructions offer a chance to live a life with dignity and self-respect, even after mutilating breast surgeries.

Another case study you may want to know : 55 year old lady 3*3 cm lump in her right breast, which increased to 7*7 cm treated successfully.

    Contact the breast cancer treatment center in Mumbai today. Schedule a consultation!



    About Author
    Dr. Jay Rashmi Anam

    Surgical Oncologists

    15+

    Year Of Experience

    Dr. Jay Anam is one of the best surgical oncologists & breast cancer specialist in Mumbai.

    Dr. Jay Anam has Completed his M.Ch. Surgical Oncology training from Tata Memorial Centre. He did his Fellowship in Breast Oncology from Centre Oscar Lambret, Lille, France.

    As a breast cancer specialist, he believes in world-class cancer care for all patients.

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