Should You Have a Mastectomy to Prevent Breast Cancer?

Breast Cancer - Overview

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Should You Have a Mastectomy to Prevent Breast Cancer?

By Lila Havens, HealthAtoZ Writer

Many women live in fear of breast cancer. While an average woman has about a 12 percent lifetime risk of getting breast cancer, some women have as much as an 85 percent risk. For these high-risk women, the fear is very real, and many of them are looking for ways to lower their risk.

One option that some very high-risk women are considering is preventive (or prophylactic) mastectomy. A woman might consider this option if she:

Is at very high risk for breast cancer and wants both breasts removed before cancer develops
Has cancer in one breast and wants the other, healthy breast removed to reduce the risk that cancer will develop there

A mastectomy is a surgical procedure done to remove nearly all of the breast tissue, where breast cancer can grow. This doesn't guarantee that a woman won't get breast cancer. It's not possible to take out every bit of breast tissue. But experts estimate that this surgery reduces the risk by about 90 percent.

Some women feel that the benefit of reducing their cancer risk is worth the cost of losing their breasts. But the choice is not clear-cut. It depends on a variety of factors, including a woman's personal risk of cancer and her own feelings.

Who may consider preventive mastectomy?
A woman might think about preventive mastectomy if she knows she is at very high risk for breast cancer. You may be at very high risk if:

You know you have a breast cancer (BRCA) gene change. The only way to know this is to have gene testing. This test is usually only done if a woman has a strong family history of breast and/or ovarian cancer.
You have a strong family history of breast cancer. You have a strong history if one or more close family members (your mother, sister or daughter) has had breast cancer, especially if she was diagnosed before age 50. Your risk may also be higher if you have both breast and ovarian cancer on one side of your family.
You have already had cancer in one breast. This means you could get it in the other breast.
You have been diagnosed with lobular carcinoma in situ (LCIS). LCIS means you have abnormal cells in the milk glands (lobules) in your breast. Doctors classify LCIS as stage 0 cancer, or precancer. It may increase your risk of breast cancer, but most women with LCIS don't get breast cancer.
You had radiation therapy to your chest before age 30.

How can I decide about preventive mastectomy?
The decision to have a mastectomy for cancer prevention is a very personal one. To make a decision that's right for you, it may help to:

Talk to your doctor or a genetic counselor so you can get a better idea of your personal risk. Women sometimes think their risks are greater than they really are.
Consider your feelings. Some women cannot imagine choosing to give up their breasts. For others, having greater peace of mind makes up for this loss.
Discuss the decision with your loved ones. Hearing what your family and friends have to say may help you decide. But, in the end, it's your body and your decision.

If you are thinking about preventive mastectomy:

Learn about the surgery and what you can expect after surgery.
Get a second opinion. The American Cancer Society urges women considering prophylactic mastectomy to meet with a second doctor to discuss their options.
Meet with a plastic surgeon if you're interested in breast reconstruction. Women often have their breasts reshaped at the time of their mastectomy.

Do I have other choices?
There are two other choices known to lower breast cancer risk.

You could take medicine to lower your risk of breast cancer. This is called chemoprevention. The chemotherapy drugs tamoxifen and raloxifene have been shown to lower the risk of breast cancer in high-risk women. Other medicines are being tested. Your doctor can tell you if one of these medicines is right for you and help you weigh the risks and benefits of chemoprevention.
You could have your ovaries removed. This lowers the risk of both breast cancer and ovarian cancer. (Women with BRCA gene changes are at high risk for both types of cancer.) But this means you can't get pregnant, and it would put you into menopause. It might be a good choice if you are through having children and are near menopause anyway.

Lifestyle
Instead of having surgery or taking medicines, many high-risk women focus on making healthy choices. These include:

Staying at a healthy weight
Eating a high-fiber diet low in salt and red meat
Getting daily exercise
Not smoking
Limiting alcohol to one drink a day

These steps may help lower an average person's risk for cancer, but no one knows if they make a difference for women at high risk.

Watch and wait
You can also choose to see your doctor for close monitoring. Having regular mammograms and clinical breast exams as well as doing self-exams can help you find breast cancer early, when it has the best chance of a cure. This helps some women feel more comfortable with their risks.

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Tue, Jan 6, 2009



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