Preventive surgery for women with very high breast cancer risk

Preventive surgery for women with very high breast cancer risk
For the few women who have a very high risk for breast cancer, surgery to remove the
breasts or ovaries may be an option.
Preventive (prophylactic) mastectomy: Removing both breasts before cancer is
diagnosed can greatly reduce the risk of breast cancer (by up to 97%). Some women
diagnosed with cancer in one breast choose to have the other, healthy breast removed as
well to prevent a second breast cancer. Breast removal does not completely prevent breast
cancer because even a very careful surgeon will leave behind at least a few breast cells.
The cells can go on to become cancerous. Some of the reasons for considering this type
of surgery may include:
· Mutated BRCA genes found by genetic testing
· Strong family history (breast cancer in several close relatives)
· Lobular carcinoma in situ (LCIS) seen on biopsy
· Previous cancer in one breast (especially in someone with a strong family history)
While this type of surgery has been shown to be helpful in studies of large groups of
women with certain conditions, there is no way to know ahead of time if this surgery will
benefit any one woman. Some women with BRCA mutations will develop breast cancer
early in life, and have a very high risk of getting a second breast cancer. Prophylactic
mastectomy before the cancer occurs might add many years to their lives. But while most
women with BRCA mutations develop breast cancer, some don't. These women would
not benefit from the surgery, but they would still have to deal with its after effects.
Second opinions are strongly recommended before any woman decides to have this
surgery. The American Cancer Society Board of Directors has stated that "only very

strong clinical and/or pathologic indications warrant doing this type of preventive
operation." Nonetheless, after careful consideration, this might be the right choice for
some women.
Prophylactic oophorectomy (ovary removal): Women with a BRCA mutation may
reduce their risk of breast cancer by 50% or more by having their ovaries surgically
removed before menopause. This is likely because the surgery removes the main sources
of estrogen in the body (the ovaries).
It is important that women with a BRCA mutation recognize they also have a high risk of
developing ovarian cancer. Most doctors recommend that women with BRCA mutations
have their ovaries surgically removed once they finish having children to lower this risk.