Sharon Osbourne’s double mastectomy raises questions about breast cancer treatment

FORMER X Factor judge Sharon Osbourne has undergone a double mastectomy because her genes show she runs the risk of contracting breast cancer. But is major surgery, when you are, in fact, healthy, really the best option, asks Natalie Walker

“I didn‘t want to live the rest of my life with that shadow hanging over me,” is how Sharon Osbourne described her reasons for having a double mastectomy. The America’s Got Talent judge has joined a growing number of women, believed to carry a gene that increases the risk of breast cancer, who have decided to have the preventive surgery.

After decades of research into the role genes play in cancer, doctors now believe around one in 20 people diagnosed with breast cancer will have developed the disease as a direct result of their family health history. The gene can be passed from both a mother or father’s side of the family.

The chances are that if a woman has close relatives with the cancer over several generations, then they are likely to have the faulty gene. Just because someone has this gene does not mean they will develop cancer, but they are considered at higher risk.

Some women who know they are in this category are opting to have both of their breasts removed before they even have any signs or symptoms of the cancer. The procedure, risk-reducing surgery, involves removing both breasts and uses tissue from another part of the body, or implants, to create new breasts. The surgery can be completed the same day or during a number of operations – most women opt to have everything done at once, experts say.

Around 1,800 mastectomies are carried out in Scotland every year, most of them will be performed on women who have been diagnosed with breast cancer. But experts now expect the number of procedures to rise, with more ‘at risk’ women opting to go under the knife despite being in good health.

Audrey Birt, Scotland Director at the charity Breakthrough Breast Cancer, says deciding to have a double mastectomy when you are not ill and do not even know if you would develop the cancer, is one of the hardest the decisions a woman can make.

She says: “Sharon Osbourne has had a difficult decision to make and has approached it with characteristic courage. We don’t know what gene fault she has had discovered but it is likely to be extremely rare.

“Women with a faulty gene have several options. Some women choose to have extra screening, starting at a younger age than women in the general population, and sometimes using MRI as well as mammography.

“This doesn’t prevent breast cancer, but it means a better chance of detecting breast cancer at an early stage when there is a higher chance of successful treatment.

“Other women, like Sharon, choose to have risk-reducing surgery. This can be either mastectomy (removal of the breasts) or oophorectomy (removal of the ovaries, which reduces the risk of both ovarian cancer and breast cancer) or both. These procedures can drastically reduce the risk of developing breast cancer. These choices are very personal and what’s right for one woman might not be right for another.”

People who think they are “at risk” can have genetic tests carried out on the NHS. The tests look for faulty genes called BRCA1 or BRCA2. Every health board in Scotland offers genetic counselling for women at high risk of developing the cancer, to look at and discuss the options available to them, including a double mastectomy.

Preventive surgery for women at risk of breast cancer has been steadily increasing over the past ten years, with experts saying it could cut the risk by more than 90 per cent.

It is thought around one in 800 women in the UK carry the defective BRCA1 gene, which gives them an 85 per cent chance of developing breast cancer. The presence of the defective gene, which is detectable by screening, also increases to 60 per cent the chance of developing ovarian cancer. Preventive techniques such as mastectomies are considered to offer the highest survival rates of all pre-breast cancer treatments. Breakthrough Breast Cancer says offering women risk-reducing surgery before they get ill is becoming the first choice of a growing number of women. For many, having the surgery is their way of dealing with the fact they are at “high risk” should they decide they do not want to take the chance of developing cancer.

Kerry Andrew is one of these women. Eight years ago when she was just 24 she had a double mastectomy after finding out she had BRACA 1 gene. She said she “did not think twice” about having the surgery after watching her mother die of breast cancer at the age of 35 (when Kerry was seven). Her grandmother was also diagnosed with the illness when she was 32 and died two decades later from ovarian cancer, which can be linked to breast cancer.

Kerry, 33, who works as a secretary, says: “I held off having the test to see if I had the gene until I was 24. I wasn’t ready for it before then. When the results came through they said what I expected, that I had it. Nothing prepares you for that but having watched both my Mum and Granny die from cancer I felt, in a way, grateful that I had the option of doing something about it.

“I did not want to spend all my time worrying about it so for me the only option was to have both breasts removed.”

Kerry had an eight-hour operation at London’s Royal Marsden Hospital. Her breasts were removed and tissue from her back was used to replace them.

She was off work recovering for six months, and says it took at least two years for her to be “fully fit again”. Even now she still suffers from pain in her back, but says she does not regret the surgery.

She says: “It is a huge deal, but it is something I wanted to do and I do not regret it for a minute. The recovery was pretty long and tough and I still have days where I am in pain. But I owed it to my mum and gran, as well as myself, to do something. Some people might think what I did was radical but it was right for me. I am delighted with my breasts now, they look better than ever. More importantly, I have been told the chances of me developing breast cancer has dropped from 85 per cent to around five. This has let me get on with my life.”

Osbourne, who had 13 hours of breast surgery, also believes the operation has enabled her to get on with her life. The former X Factor judge, now 60, who beat colon cancer a decade ago, made her choice after tests showed she carries a gene which increased the risk of developing breast cancer.

“As soon as I found out I had the breast cancer gene, I thought, ‘The odds are not in my favour,’” she told Hello! “I’ve had cancer before and I didn’t want to live under that cloud. I decided to just take everything off, and had a double mastectomy. For me, it wasn’t a big decision, it was a no-brainer. I didn’t want to live the rest of my life with that shadow hanging over me. I want to be around for a long time and be a grandmother to Pearl.

“I didn’t even think of my breasts in a nostalgic way, I just wanted to be able to live my life without that fear all the time. It’s not ‘pity me.’ It’s a decision I made that’s got rid of this weight that I was carrying around.”

BACKGROUND

The precise reasons why people develop breast cancer are still unknown, but are thought to be a combination of genetic, environmental and lifestyle factors.

Scientists have now identified many genes which are more likely to be defective in people with breast cancer. However, genetic abnormalities are currently thought to be responsible for only approximately one in 20 breast cancer cases.

Having a significant family history of breast cancer, which may be associated with inherited gene mutations, is now believed to be one of the causes.

Women are believed to be more at risk of gene-related breast cancer if:

• A relative has been diagnosed with breast cancer under the age of 40.

• A close relative had or has cancer in both breasts.

• A male relative had or has breast cancer.

• Two close relatives on the same side of the family have been diagnosed with breast cancer under 60 or with ovarian cancer.

• Three close relatives have been diagnosed with breast or ovarian cancer at any age.

• If some other uncommon cancers have occurred in close family members, for example: ovarian cancer, sarcoma in someone younger than 45, a glioma, or childhood adrenal cancer.

• If you come from certain ethnic backgrounds such as the Ashkenazi Jewish community which has a higher incidence of genes which increase the cancer risk.