Denise Mann

Denise Mann

October was first deemed National Breast Cancer Awareness Month more than 25 years ago. But before you flip back to see what issue of Plastic Surgery Practice you are reading, this is the September issue.

So why am I writing about breast cancer awareness month in September?

There’s a good reason.

The unbridled success of breast cancer advocates and researchers in raising awareness and money have helped usher in tremendous advances in the prevention, screening, and treatment of this cancer.

Have we cured breast cancer yet? No, but we are closing in on the cancer which will affect one in eight US women. In particular, we have made great strides when it comes to earlier identification of at-risk women. Women – and men – can now be tested for the BRCA1 or BRCA2 genes which increase their risk for hereditary breast and ovarian cancer.

According to statistics from FORCE: Facing Our Risk of Cancer Empowered, 2.3 million women in the US may be at increased risk for breast and ovarian cancer because of their family history, and an estimated 750,000 people in the US carry a BRCA1 or BRCA2 gene mutation.

In 2010, FORCE urged Congress to declare the last week in September as National Hereditary Breast and Ovarian Cancer Week. This year the week spans from September 23-30, and right smack in middle of this week, September 26, 2012, is “pre”vivor day. Previviors are women who have undergone prophylactic mastectomy and/or oophorectomy to reduce their risk of ever developing these cancers.

Herculean and well-needed efforts are currently under way to educate breast cancer survivors about their reconstructive option after breast cancer surgery. October 17 marks the first annual Breast Reconstruction Awareness or “BRA” Day. This initiative is a collaborative effort between the American Society of Plastic Surgeons, the Plastic Surgery Foundation, and others, and it is gaining traction. Plastic surgeons are increasingly being invited to the table when newly diagnosed women are making their initial treatment decisions.

But previvors and future previvors should not fly under the radar. These women are brave and strong. They are pioneers who are proactively taking control of their own destiny in a way that would have been unheard of decades ago. As such, they will also need to know what they can, and should, expect after their complete or partial mastectomy. Plastic surgeons need a seat at this table too.

For these women, the team should be a gynecologist, radiologist, breast surgeon and oncologist, plastic surgeon, and a genetic counselor. These individuals must be counseled before and after they get tested for these genes. Plastic surgeons should consider reaching out to local gene counselors. Information about reconstruction options when presented in a sensitive and appropriate manner may allow some women to feel more comfortable with a very difficult decision.

Many questions still need to be answered about this important and growing patient population. How are they different from women with breast cancer? Some may be younger, and as such may have different cosmetic concerns as well as concerns about childbearing and breast-feeding. There are some surgical differences as well. Prophylactic mastectomies may not involve the removal of as much skin, and may be more likely to be nipple- and areola-sparing. These factors can make reconstruction easier. The emotional issues should not be overlooked. There is a big difference between having surgery to remove your breast because you have cancer versus removing your breasts because you are at high risk for cancer.

These are some of the issues that should be on researchers’ and physicians’ minds before, during, and after National Hereditary Breast and Ovarian Cancer Week.