Breast cancer is the most common cancer in women and the second most common cancer worldwide, the first being lung cancer.

About five to 10 per cent of all breast cancers are thought to be hereditary, caused by defective genes being transferred from the mother or the father to their child. In fact, a child has a 50 per cent chance of inheriting a mutated gene if either his mother or father carries one of these faulty genes.

Hollywood star Angelina Jolie has had a double mastectomy and also removed her ovaries to reduce her risk of contracting both breast and ovarian cancer. Photos: Reuters

Think of your genes as an instruction manual for cell growth and function. A defective gene may result in cells growing and replicating out of control resulting in the formation of a tumour. Two of the most common examples of these genes are the BRCA1 and BRCA2 genes. Being a carrier of the BRCA1 or BRCA2 mutated gene gives a woman a 45-90 per cent lifetime risk of breast cancer as well as 50 per cent risk of ovarian cancer. These genes also increase the risk of breast cancer in men.

Famous actress Angelina Jolie carries a mutated BRCA1 gene that increased her likelihood of having breast and ovarian cancer. Her mother died at the age of 56 due to ovarian cancer. Jolie chose to have a double mastectomy and also removed her ovaries to reduce her risk of contracting both breast and ovarian cancer. A person may undergo genetic testing, most often consisting of a blood test, to find out whether they carry the mutated BRCA1/2 gene or not.

But more often than not, breast cancer is not acquired genetically but due to an environmental carcinogen (something which induces the formation of cancer) or a virus which causes a gene to mutate. This type of mutation is called an acquired mutation. Lifestyle factors such as smoking, pollution, workplace environment and certain medical treatments like radiation may all contribute to the formation of cancer.

Famous pop singer Anastacia, who performed in Malta this year, was first diagnosed with breast cancer in 2003 and was treated with a breast conserving surgery called a ‘lumpectomy’, in which only the tumour is removed and the breast is conserved, but this does not eliminate the risk that the breast cancer may reappear again.

In fact, in 2013, Anastacia felt a lump on her right breast which was a sure indication that her cancer had relapsed. This time she immediately requested a double mastectomy to greatly reduce the chance of having further breast cancer once and for all.

In an interview in 2008, Anastacia said: “More and more women today are getting cancer which is not gene related. I’m sure it was stress which caused mine.”

Deciding between mastectomy and lumpectomy can be difficult

Deciding between mastectomy and lumpectomy can be difficult. A mastectomy results in a permanent loss of the breast, so it also has a psychological impact apart from the risks of the operation itself which is longer and more extensive then lumpectomy.

On the other hand, lumpectomy is a less invasive surgery and preserves most of the breast, but the likelihood for breast cancer to reappear is much higher. After lumpectomy, a person is usually treated with five to seven weeks of radiation therapy which can be quite harmful. Fortunately, newer mastectomy techniques which incorporate strong plastic surgical input have recently been developed to preserve as much of the breast skin as possible in order to allow a more natural breast after the operation. These techniques are in fact called ‘oncoplastic’ surgical techniques.

Following a mastectomy, a surgical procedure called ‘breast reconstruction’ may be done to rebuild the breast and make it look as natural as possible. Apart from the breast itself, the nipple and the dark area around the nipple (areola) may be added as well.

A breast reconstruction consists mainly of a breast implant, a tissue flap consisting of a section of your own body tissue (eg. skin, fat and muscle) which is removed from an area of the patient’s body and added to the chest area, or a combination of both implants and tissue flap.

Breast reconstruction is quite a safe procedure although there can be some risks and side effects. These include wound infections post-surgery, poor wound healing, pain and discomfort and flap failure, which is one of the main problems with body reconstruction because the flap of tissue used to make the breast may die. Also the breast implant itself may cause problems like leakage, hardening or changing shape.

All women, especially those aged 40 or older should undergo regular breast check-ups, which can take the form of clinical examination for any suspicious lumps or imaging tests such as ultrasound and mammogram.

Mammograms are not advised in younger women since their breast tissue is denser and the mammogram is harder to read. Mammograms themselves expose the woman to X-rays which may be harmful, therefore they should only be taken as advised by a healthcare professional.

Malta has a free breast screening programme where women between the ages of 50 and 60 are offered mammograms every three years.

Around 14,000 Maltese women are invited for screening every year. It also important to note that women who have a higher risk of contracting breast cancer due to inheritance of a mutated gene or a family history should start screening at a younger age and have it done more frequently.