PROPHYLACTIC MASTECTOMY

“Should I just get my breasts removed?”

This is not an uncommon question when sitting with a woman who has just been told that she is at high risk for breast cancer. The emotions and the shock that accompany this type of news bring a range of thoughts and fears. It is a question that has received a significant increase in medical press over the past couple of years and should be part of this discussion. Several years ago, the Mayo Clinic published a paper (Jan 14, 1999 issue of The New England Journal of Medicine.) on the use of Prophylactic Mastectomy (which is the surgical removal of one or both breasts) to reduce the incidence of primary or recurrent breast cancer in high risk women. This brought the discussion into the forefront as we understand a little more about the risk factors for breast cancer. According to the 2009 statement on Prophylactic Mastectomy (PM) issued by the Society of Surgical Oncology, there are some potential indications for bilateral PM in patients without a Cancer diagnosis. These would include: • A known mutation of BRCA 1 or BRCA 2 or other strongly predisposing breast cancer susceptibility genes as found by genetic testing. • A family history of breast cancer in multiple first degree relatives and/or multiple successive generations of family member with breast and/or ovarian cancer • High risk histology such as atypical ductal or lobular hyperplasia or lobular carcinoma in situ on biopsy. Some potential indications for PM of the contralateral (or other) breast for those who have had a previous or current diagnosis of breast cancer also exist and include the following: • For risk reduction in patients at high risk for a contra-lateral breast cancer (as listed above) • For patients in whom subsequent surveillance of the contra-lateral breast would be difficult due to the density, presence of diffuse microcalcifications, or other factors of the breast. • For improved symmetry in patients undergoing mastectomy with reconstruction. Prophylactic mastectomy is highly effective. Studies show it reduces the risk of developing breast cancer by 90 percent in moderate- and high-risk women. However, if you're at high risk of breast cancer and you decide against prophylactic mastectomy, you do have other options.  • Surveillance. The goal of surveillance is to detect cancer at its earliest stage.This would include both clinical breast exam as well as breast imaging studies such as magnetic resonance imaging (MRI), ultrasound and mammogram starting at a younger age than usual, sometimes as early as age 25 years. • Chemoprevention. In this approach, you may prevent breast cancer by taking drugs that block the effects of estrogen, because estrogen can promote breast cancer development and growth. • Tamoxifen and a similar drug — Raloxifene (Evista) —have been shown to reduce the risk of invasive breast cancer by approximately 50 percent. However, they come with serious risks, including blood clots and strokes, as well as side effects, such as hot flashes and vaginal dryness. • Lifestyle. You may reduce your risk of breast cancer if you exercise regularly, limit alcohol use, maintain a healthy body weight, breast-feed for at least several months and avoid long term postmenopausal hormone therapy. Only women with a high risk of developing breast cancer should consider prophylactic mastectomy, and even then, the decision can be difficult. Researching your options and talking with your doctor and the staff at the Covenant Comprehensive Breast Center can give you the information you need to help decide whether this option is right for you.