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Prophylactic mastectomy: Breast cancer prevention for high-risk women
Deciding against surgery
If you're at high risk of breast cancer and you decide against prophylactic mastectomy, you do have other options:
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Surveillance. The goal of surveillance is to detect any possible cancer at its earliest stage. If you have positive results from gene testing, your doctor may recommend you do a breast self-exam every month beginning in your early 20s. Your doctor may also recommend clinical breast exams once or twice a year beginning in your mid-20s. Annual mammograms may be recommended when you're 25 to 35.
If you have a family history of breast cancer that doesn't seem related to a mutation in BRCA1 or BRCA2, your doctor may recommend that you begin annual mammograms by age 40, or about five to 10 years before the age at which your youngest affected first-degree relative was diagnosed with breast cancer (whichever comes first). For example, if your mother had breast cancer at 40, you'd start your mammograms at 30 or 35.
Women who carry the BRCA 1 or 2 gene or are at very high risk are being offered annual breast MRI screening in addition to mammography to screen for breast cancer.
- Chemoprevention. In this approach, you prevent breast cancer by taking drugs that block the effects of estrogen. Tamoxifen (Nolvadex), the first drug used for this purpose, has long been prescribed to prevent breast-cancer recurrence in women who have already been treated for estrogen-receptor positive cancer. More recently, a similar drug — raloxifene (Evista) — was approved for preventing invasive breast cancer in postmenopausal women at high risk of developing the disease. Both drugs have been shown to reduce the risk of invasive breast cancer by approximately 50 percent.
A difficult decision
Only women with a high risk of developing breast cancer are candidates for prophylactic mastectomy, and the decision can be difficult to make. Researching your options and talking with your doctor can give you the information you need to decide whether prophylactic mastectomy is right for you.
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