Surgery can dramatically reduce genetic cancer risk

Updated 16 May 2013
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Surgery can dramatically reduce genetic cancer risk

Women whose genes put them at a high risk of contracting breast cancer can dramatically reduce the danger by having a double mastectomy — but not eliminate it altogether, experts say.
The issue has been thrown into the spotlight with Hollywood star Angelina Jolie’s announcement that she had her breasts surgically removed after tests revealed she carried a genetic mutation that can lead to cancer.
Rocker Ozzy Osbourne’s wife, Sharon, did the same last year.
About 0.2 percent of women carry a harmful mutation in the BRCA1 or BRCA2 gene that boosts their lifetime risk of contracting breast cancer to as much as 80 percent compared to about 10 percent for women without the gene. “This is what many people would consider a sky-high risk,” epidemiology professor Per Hall of Sweden’s Karolinska Institutet told AFP. “For the few women who are carriers (of the mutation) this is definitely a good option,” he said of surgery.
Having a double mastectomy reduces a mutation-carrier’s risk by about 90 percent to a level lower than that of women who don’t carry the genetic flaw. But it but can never eliminate the danger entirely.
“Even the most skilled surgeon will leave some tiny part of breast tissue behind,” said Hall.
An estimated 458,000 women died of breast cancer — the most common cancer type among women — in 2008, according to the World Health Organization (WHO).
Survival rates vary greatly, from 80 percent in the developed world to under 40 percent in poor countries that have fewer early-detection programs. The cost of genetic screening can be prohibitive — ranging from several hundred to several thousand dollars, says the US-based National Cancer Institute.
On its website, the WHO says early detection remains the “cornerstone” of its cancer strategy as preemptively screening asymptomatic people was a “far more complex undertaking.”
DNA, the blueprint for life, comprises four basic chemicals called A (adenine), C (cytosine), T (thymine) and G (guanine) strung together in different combinations along a double helix.
Sometimes a “spelling mistake” in the A, C, T, G combinations can cause problems in gene function.
But carrying a mutation does not necessarily mean a person will develop cancer — factors like lifestyle also play a role. A study in 2005 concluded that a fifth of breast cancer deaths worldwide could be attributed to alcohol use, excessive weight and physical inactivity.
Delayed pregnancy and not breastfeeding are factors considered to increase one’s chances of contracting breast cancer.
Age is a major factor — most breast and ovarian cancers occur in women over 50, though women with the BRCA mutations often get ill at an earlier age.
Mutations in the BRCA (BReast CAncer susceptibility) genes, which normally act as tumor suppressors, also increase ovarian cancer risk.
Clinical geneticist Clare Turnbull at the Royal Marsden Hospital in London said women who carry the mutation are generally offered intensive MRI and mammogram screening so any cancer can be caught and treated early.
“That is one option, and for many women particularly young women, that’s the option they choose,” she told AFP.
“Other women feel that they would like to take a more interventional approach and try and reduce the likelihood of them getting cancer in the first place,” such as a double mastectomy.
“It is not uncommon.”
The London-based Breast Cancer Campaign said Jolie’s openness would help raise crucial awareness of genetic breast cancer risk.
“Deciding whether to have preventative surgery is a heart rending decision for women like Angelina but we know it’s a vital way of saving lives,” the campaign’s chief executive Delyth Morgan said.
“This is a stark reminder of how much more research we need to do to give women more knowledge, choice and life-saving options to reduce their risk.”


Gaming addiction classified as mental health disorder by WHO

Updated 18 June 2018
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Gaming addiction classified as mental health disorder by WHO

  • Addiction to video games has been recognized by World Health Organization as a mental health disorder
  • The International Classification of Diseases now covers 55,000 injuries, diseases and causes of death

GENEVA: Obsessive video gamers know how to anticipate dangers in virtual worlds. The World Health Organization says they now should be on guard for a danger in the real world: spending too much time playing.
In its latest revision to a disease classification manual, the UN health agency said Monday that compulsively playing video games now qualifies as a mental health condition. The statement confirmed the fears of some parents but led critics to warn that it may risk stigmatizing too many young video players.
WHO said classifying “gaming disorder” as a separate addiction will help governments, families and health care workers be more vigilant and prepared to identify the risks. The agency and other experts were quick to note that cases of the condition are still very rare, with no more than up to 3 percent of all gamers believed to be affected.
Dr. Shekhar Saxena, director of WHO’s department for mental health and substance abuse, said the agency accepted the proposal that gaming disorder should be listed as a new problem based on scientific evidence, in addition to “the need and the demand for treatment in many parts of the world.”
Dr. Joan Harvey, a spokeswoman for the British Psychological Society, warned that the new designation might cause unnecessary concern among parents.
“People need to understand this doesn’t mean every child who spends hours in their room playing games is an addict, otherwise medics are going to be flooded with requests for help,” she said.
Others welcomed WHO’s new classification, saying it was critical to identify people hooked on video games quickly because they are usually teenagers or young adults who don’t seek help themselves.
“We come across parents who are distraught, not only because they’re seeing their child drop out of school, but because they’re seeing an entire family structure fall apart,” said Dr. Henrietta Bowden-Jones, a spokeswoman for behavioral addictions at Britain’s Royal College of Psychiatrists. She was not connected to WHO’s decision.
Bowden-Jones said gaming addictions were usually best treated with psychological therapies but that some medicines might also work.
The American Psychiatric Association has not yet deemed gaming disorder to be a new mental health problem. In a 2013 statement, the association said it’s “a condition warranting more clinical research and experience before it might be considered for inclusion” in its own diagnostic manual.
The group noted that much of the scientific literature about compulsive gamers is based on evidence from young men in Asia.
“The studies suggest that when these individuals are engrossed in Internet games, certain pathways in their brains are triggered in the same direct and intense way that a drug addict’s brain is affected by a particular substance,” the association said in that statement. “The gaming prompts a neurological response that influences feelings of pleasure and reward, and the result, in the extreme, is manifested as addictive behavior.”
Dr. Mark Griffiths, who has been researching the concept of video gaming disorder for 30 years, said the new classification would help legitimize the problem and strengthen treatment strategies.
“Video gaming is like a non-financial kind of gambling from a psychological point of view,” said Griffiths, a distinguished professor of behavioral addiction at Nottingham Trent University. “Gamblers use money as a way of keeping score whereas gamers use points.”
He guessed that the percentage of video game players with a compulsive problem was likely to be extremely small — much less than 1 percent — and that many such people would likely have other underlying problems, like depression, bipolar disorder or autism.
WHO’s Saxena, however, estimated that 2 to 3 percent of gamers might be affected.
Griffiths said playing video games, for the vast majority of people, is more about entertainment and novelty, citing the overwhelming popularity of games like “Pokemon Go.”
“You have these short, obsessive bursts and yes, people are playing a lot, but it’s not an addiction,” he said.
Saxena said parents and friends of video game enthusiasts should still be mindful of a potentially harmful problem.
“Be on the lookout,” he said, noting that concerns should be raised if the gaming habit appears to be taking over.
“If (video games) are interfering with the expected functions of the person — whether it is studies, whether it’s socialization, whether it’s work — then you need to be cautious and perhaps seek help,” he said.