Could MEN need surgery to beat Angelina Jolie's cancer gene?

By Dr Ellie Cannon

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Saving surgery: Actress Angelina Jolie had a double mastectomy after discovering the BRCA1 gene

Saving surgery: Actress Angelina Jolie had a double mastectomy after discovering the BRCA1 gene

Since Hollywood star Angelina Jolie revealed she had undergone a preventative mastectomy, newspapers have been awash with further reports and case studies of women opting for such radical surgery.

It also emerged last week that a British father underwent similar pre-emptive surgery – in his case, having his prostate removed – after discovering that he carries a defective gene that boosts his risk of cancer.

This was a landmark case but it also raises many questions for men and about the future of genetic testing.

How does the BRCA gene affect men?

There are two BRCA genes, known as BRCA1 and BRCA2.

We know that in women these confer a risk of breast and ovarian cancer. More recent research has looked at the effects of these genes on men.

What emerged from the most recent studies is that BRCA2 particularly seems to be associated with a much higher chance of developing aggressive prostate cancer.

At this stage the studies cannot conclude just how much greater a man’s risk is, but the Institute of Cancer Research has published data showing a definite link.

Future research into the genetics will allow the exact risk to be quantified, as it has been for breast cancer.

I thought prostate cancer was a non-aggressive form of cancer?

In the majority of cases, prostate cancer is a slow-growing cancer that may not require treatment other than observation: this tends to be the type that men get in their 70s or 80s.

However, BRCA genes have been linked with the much more aggressive form which affects younger men and spreads much faster.

 

Could preventative prostate surgery become a reasonable option for men?

Certainly not at this stage. The British man’s surgery was the first of its kind and it is important to highlight it was not strictly preventative: he already had the very earliest of signs of prostate cancer too. He was involved in a research trial and was known to be BRCA2-positive.

The gene alone would not have been reason enough to remove his prostate, but the medical team involved agreed to such radical surgery because he had both the gene and the first signs of cancer.

There are major downsides to prostate surgery when compared, for example, with preventative mastectomy. Men can suffer impotence, ejaculation problems and incontinence after surgery.

Danger gene: Research published buy the Institute of Cancer Research show that the BRCA2 gene has a definite link to a higher risk of developing prostate cancer

Danger gene: Research published buy the Institute of Cancer Research show that the BRCA2 gene has a definite link to a higher risk of developing prostate cancer

 As a man, how could I find out if I am BRCA-positive?

Discuss your family history of cancer with your GP. Family history is a red flag when there are numerous cases of cancer in the under-60s. If you have a strong family history of prostate or breast cancer, your GP can refer you for genetic testing. Those with a family history of bowel cancer are referred for surveillance too.

 My family has a history of breast cancer but we do not carry the BRCA gene. Where does that leave my risk?

This is a situation faced by many women, including me: my grandmother and mother have had breast cancer, but do not have the BRCA genes.

What we don’t know in these cases is which genes are present that could be giving the increased incidence – not all cancer-causing genes have been identified, so they cannot be tested for. In these cases, risks have to be quantified by a family-history clinic.

Staff assess the age of the patient and severity of the cancers, then help weigh up the benefits of preventative surgery. It would be far less clear than for BRCA-positive families but it may be considered. However, the usual course of action is to remain under close surveillance through regular screening.

The comments below have not been moderated.

She also has a higher risk of ovarian cancer - so does this mean she's going to have a hysterectomy? Seems she hasn't taken this step - I wonder why not?

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Having worked in a cancer hospital the answer is YES.

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To Julia - sorry for misunderstanding your comment. I do understand you view on the medical business and how they are ruthless and just wants to earn billions. I personally think Angelina did the test and had time to think through this carefully before selecting the option she did. Her mother, aunt, uncle, grand and great grandmother all died young because of cancer. I totally understand her fear of not being there for her children and I probably would have done exactly the same thing. Angelina might let the fear rule her but the odds of surviving wasnt in her favour. Hopefully Angelina will lobby the parliament to make these kinds of tests and treatments free for everyone in USA. It's free in most countries world wide and her article has made millions of women call their doctors to inquire about these tests.

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To Justa Thought- I do not accuse Angelina of having a mastectomy to make money,she obviously has a genetic risk and a great fear of cancer,which her mother died of. It is the publicity surrounding the operation that is dubious she could have kept it a secret,with her surgeon even publicly describing in detail how he did it. These US and international companies are completely ruthless in their drive to make money for their shareholders,sometimes to the detriment of the public good.Look at the promotion of statins -cholesterol lowering drugs- by the pharmaceutical companies. There is no doubt they benefit some,but they have been persuading physicians to medicate the whole population over 50,though side-effects are considerable and it has been shown that they do not prevent heart diease in the population at large.I am with Kirstie Allsop on this-before taking drastic steps a person needs to think carefully. Fear is not a good basis for an irreversible clinical decision.

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Why is she promoting mutilation of the body? There are many mistakes to be made and prevention is the answer. How much money is she going to make from this action?- Agatha King , Toronto, Canada, 26/5/2013 03:42 I am glad that I am not as cynical and inhuman as you have become. So you are actually accusing Angelina of cutting of her breasts for publicity and money. You are also attacking people who take preventative measures to make sure they can live longer. So tell me would you aboard a plane where there is 87% change of an explosion? Wouldn't you take preventatives measures to stay behind or to make sure the percentage of the explosion of the plane will be reduced to much lower?

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The Angelina story is clearly a PR ruse that has been paid for as an investment.

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Why is she promoting mutilation of the body? There are many mistakes to be made and prevention is the answer. How much money is she going to make from this action?

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To coincide with Angelina Jolies bombshell,the corporation Myriad Genetics has recently had a patent granted on this genetic test. The corporation stands to make billions,if there is a huge increase in genetic testing due to this publicity. I would urge any woman -or man- not to even considered having this test unless 2 or more close relatives have developed breast or ovarian cancers before fifty ,otherwise there will an outbreak of women having mutilating surgery for a disease they do not have.

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