Preventive Surgery

Double Mastectomy

Preventive surgery (prophylactic mastectomy) has been studied in women who are at high risk of getting breast cancer because they carry a mutation on the BRCA1 or BRCA2 gene. These studies show that in these women preventive mastectomy reduces breast cancer risk by 90%. Why not 100%? No mastectomy can be guaranteed to remove all the breast tissue, which extends from the collarbone to below the rib cage, from the breastbone around to the back. Further, it doesn’t separate itself out from the surrounding tissue in any obvious way.

Currently risk reduction surgery is recommended only for women who are at very high risk of breast cancer. This includes women with:

  • a BRCA1 or BRCA2 mutation
  • a strong family history of breast cancer
  • lobular carcinoma in situ (LCIS) and a strong family history of breast cancer
  • a history of radiation therapy to the chest before the age of 30.

Ovarian Removal

n 2014, researchers published results from a large study that found preventive removal of the ovaries and the fallopian tubes (bilateral salpingo-oophorectomy) was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer in BRCA1 or BRCA2 carriers and a 77% reduction in all-cause mortality. Ovarian removal also reduces breast cancer risk by 47 to 61%. The studies suggest the oophorectomy may have the most benefit if is done as soon as possible after a woman has completed her childbearing.

If all this seems overwhelming, remember you don’t have to have both surgeries at the same time. Having a genetic risk of breast cancer is not an emergency, and you do not have to rush. Take your time to decide what is appropriate for you, and don’t be afraid to change your mind over time.

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