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Is a preventive mastectomy worth the risk?

Actress Angelina Jolie put a spotlight on the issue, but it is something women have been facing for years: If I have a high risk for breast cancer, should I have a mastectomy even if I haven’t been diagnosed with breast cancer? While a risk-reducing mastectomy is not the best option for every woman, it can be beneficial to those who meet certain criteria, says Nicole Sroka, M.D., a breast surgeon at Piedmont Fayette Hospital.  These criteria include a family history of the disease, gene mutations and other risk markers.

Family history

Women with a strong family history of breast cancer have likely watched their loved ones undergo surgery, chemotherapy, radiation and the side effects that come with these treatments. To avoid going through treatment, some women elect to have one or both breasts removed in hopes of preventing breast cancer all together.

“I think that’s the mindset that women with strong family histories come in with, asking about mastectomies,” says Dr. Sroka. “At the end of the day, when we look at the data, there is a certain group of women who benefit from prophylactic mastectomy or risk-reducing mastectomy.”

Gene mutations

In addition to those with a family history, women with certain genetic mutations, most notably BRCA1 and BRCA2, may benefit from preventive mastectomy. For these women, it’s not a matter of “if,” but “when,” says Dr. Sroka.

In this case, a risk-reducing mastectomy makes sense.

“When we look at these women, they have anywhere between a 60 and an 80 percent risk of developing breast cancer at some point in their lives,” she says. “There is data suggesting that we have improved survival for those groups of women.”

For women without the BRCA1 or BRCA2 gene mutation, but with a strong family history, research indicates that preventive mastectomy may be beneficial as well.

Other markers of increased risk

There is a third group of women who also may benefit from the surgery. These women do not have breast cancer, but have markers of increased risk, such as atypical cells or a process called lobular carcinoma in situ, a condition that occurs when abnormal cells grow in the breast’s lobules, or milk glands.

“Their risk approaches anywhere between 16 and 25 percent of developing breast cancer in their life,” says Dr. Sroka. “For that group of women, there is some suggestion that we can help reduce their risk of getting breast cancer. However, some studies show overall survival is about the same.”

Making the decision

It is important that the patient and her physician discuss her overall risk of developing breast cancer, her mortality risk for breast cancer, and the complications that can arise from undergoing the surgery. These include not only complications from the surgery itself, but self-esteem issues later in life. The decision to have a risk-reducing mastectomy isn’t one that should be taken lightly, says Dr. Sroka.

“It’s one of those conversations that needs to last a long time, especially if the patient doesn’t have the genetic mutation,” she says. “If this still seems like the best option for them, it’s important that they are comfortable with their choice five, 10 or 15 years down the road.”

For more information on breast cancer, visit Piedmont Cancer Center.

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