Should a young woman who carries the BRCA gene be “mutilated” by surgery to avoid the risk of breast cancer?

I’m often asked this question, which must haunt many young women and their mothers:

"Due to a genetic mutation that is transferred from mother to daughter, I have an aggressive breast cancer. Now my doctors have proposed that my 12 year-old daughter should have her breasts and ovaries removed while she is a teenager, to avoid the risk that she might develop the same disease. She will be surgically mutilated. What’s your opinion of this procedure?”

I’m familiar with this type of advice and I think the pros and cons need to be carefully weighed in such cases. It’s important to realize that the risk of developing cancer related to the BRCA1 and BRCA2 genes is almost three times higher for women born after the Second World War than it is for those born before 1939. The risk is also much higher for women who are obese or overweight at adolescence, and for those who do no physical exercise. (1, 2).

This is absolute proof that it is the interaction between these genes and factors involving life-style and environment that causes cancer, rather than genes alone. Thus it is possible to influence the probability that cancer will appear, using life-style modifications like those I describe in Anticancer: A New Way of Life, along with regular tests to detect the presence of cancerous cells in the breast in case the disease does nonetheless appear. This option seems to me far preferable than pre-emptively choosing to mutilate a young child. However, your choice must depend on your individual tolerance of risk.

1. Antoniou A, Pharoah PDP, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. American Journal of Human Genetics 2003;72(5):1117-30. 2. King M-C, Marks JH, Mandell JB, Group NYBCS. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 2003;302(5645):643-6.