The first was Angelina Jolie. A few years later the model Bianca Balti also made the same choice. A difficult and courageous choice. Both decided to have preventive surgery, undergoing a bilateral mastectomy, to avoid cancer. Both had the mutation of the Brca1 and Brca2 genes, which predisposes, in an early and aggressive way, to a greater risk of breast and ovarian cancers. “Their choice, in Italy, has caused a lot of discussion. Yet it is the only plausible one. The alternative is to wait for the tumor to arrive”, says Marzia Salgarello, reconstructive plastic surgeon at the Agostino Gemelli Irccs University Polyclinic Foundation and president of Beautiful After Breast Cancer (Babc) Italia Onlus.
“Unfortunately, ordinary women are denied the possibility of preventive bilateral mastectomy – he underlines – unless they are able to bear the costs by resorting to the operation privately. The National Health System, in fact, does not include this procedure in the Lea, not even for women with BRCA mutation”. Precisely for them, the expert instead calls for “a new strategy”.
In Italy, breast cancer is the most frequently diagnosed one. In 2020, according to the Aiom-Airtum Report 'Cancer numbers 2020', 54,976 cases were estimated in the female population, 30.3% of all cancer forms. According to data from the Higher Institute of Health 5-10% of breast cancers are hereditary, i.e. linked to the presence of mutations in the Brca1 and Brca2 genes, which are mainly responsible for the predisposition to develop cancer. Men can also be affected, particularly at a young age, especially due to the presence of mutated BRCA2. Typically, these are aggressive tumors that affect younger people.
According to data released by aBRCAdabra – the first national association to support all carriers of BRCA genetic mutations and their families, which is fighting to ensure that the right to genetic testing is extended throughout the national territory – in Italy there are approximately 150,000 such have these mutations, 1 person in every 400, without distinction between men, women, adults and children. Mutations in the BRCA genes can be passed on to children, both male and female, with a 50% probability with each new pregnancy.
After discovering it by carrying out a genetic test, for those who have the mutation Jolie genes – as she was renamed after the actress' choice to have a preventive mastectomy and talk about it publicly – the options are active surveillance or, for those who can afford it, preventive surgery. Active surveillance means constantly checking yourself “with mammography and magnetic resonance imaging every year and ultrasound every 6 months”, explains Liliana Barone Adesi, medical director of the Plastic Surgery Operational Unit, Agostino Gemelli Irccs University Polyclinic Foundation, and vice-president of Babc Italia Onlus. The goal is to diagnose cancer as early as possible. But “in this case the presence of the tumor would still affect the patient's prognosis and would force her to need oncological treatments which would be avoided in the case of prophylactic surgery”, she underlines. Women, the experts point out, “must have this possibility. They must be able to choose preventative surgery. Waiting for cancer to arrive is not a possible solution”.
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