Prophylactic (Elective) Mastectomy

Prophylactic (Elective) Mastectomy

If you have a high risk for breast cancer, you may have considered prophylactic (elective) mastectomy. Most women who consider this option think that if they eliminate the area of risk, they also eliminate the risk of cancer. This is a very drastic solution and one that is not guaranteed to put an end to your risk. There is no mastectomy that can guarantee that all the breast tissue is removed. Your breast tissue extends itself from your collarbone to your below your ribcage and around to your back. There is no separation between breast tissue and other body tissues, so no surgeon, no matter how wonderful, could be sure to get all the breast tissue in your body. While prophylactic mastectomies most likely do remove some of the risk, there is no way of knowing how much. At BreastHealthOnline, we would want you to be sure of all the risks and complications, both physical and emotional, involved in this sort of surgery. If, at the end of your research, your discussion with several highly reputable doctors who are up to date on the latest research in breast cancer, and deep thought on your part, you still feel that prophylactic mastectomy is for you, we provide the following information.

What is prophylactic mastectomy?

According to a statement from the American Cancer Society Board of Directors, "Only very strong clinical and/or pathological indications warrant doing this type of 'preventive operation.'" The surgeon removes both breasts, the skin and the nipples. This is the same as a simple mastectomy. Because there is no cancer present, the lymph nodes are not removed. Reconstruction can be done immediately or at a later date.

Who is a candidate for prophylactic mastectomy?

Women who are at high risk of breast cancer who may wish to consider prophylactic mastectomy after weighing other preventive options for breast cancer, including:

* A strong family history of breast cancer (especially if the breast cancer was diagnosed among several first-degree relatives -- mother or sisters -- before age 50)
* Having tested positive for the BRCA1 or BRCA2 gene mutations
* A personal history of breast cancer and a high risk for recurrence
* Perhaps those who have been diagnosed with lobular carcinoma in situ (a marker for increased breast cancer risk)

This is an irreversible procedure, so women who are considering it should be sure to talk with several surgeons, women who have had prophylactic mastectomies, family, friends, and a professional counselor who has experience dealing with patients who have considered this surgery.

What are Alternatives to Prophylactic Mastectomy to Help Lower Breast Cancer Risk?

Frequent monitoring:

If you are at high risk for breast cancer, you should be closely monitored by a physician, as well as having frequent clinical breast exams and mammograms. Because breast affects approximately one in eight women, all women should follow the guidelines set forth by the American Cancer Society, the American College of Radiology, the American College of Surgeons, and the American Medical Association.

Being monitored closely by your physician will increase your chances of finding any cancer early. The earlier breast cancer is detected, the greater the chances for successful treatment and survival.

If you have a family history of breast cancer or if you test positive for the BRCA1 or BRCA2 gene mutations, you may want to talk to your physician about beginning annual screening mammograms earlier than age 40 -- as early as age 25 in some cases.

Tamoxifen:

In 1998, the U.S. Food and Drug Administration approved the use of tamoxifen (Nolvadex) for use in breast cancer prevention. Research by the National Adjuvant Breast and Bowel Project found that tamoxifen taken as a preventative for five years reduced the incidence of breast cancer by 49%. For women who have a high risk of developing breast cancer, you might want to discuss this option with your doctors.

Clinical Trials

If you are a woman with high risk of developing breast cancer, you might want to research the availability of any clinical trials regarding prevention of breast cancer. Currently the National Adjuvant Breast and Bowel Project is conducting the STAR (Study of Tamoxifen and Raloxifene) trials, to determine if raloxifene is as effective as tamoxifen in preventing breast cancer. You can find out more information on clinical trails by visiting the National Cancer Institute Clinical Trial page at http://www.cancer.gov/ or by talking to your local breast cancer clinic, hospital, or doctor.

Again, please realize that prophylactic mastectomy is not a guarantee that you will never get cancer. True cancer prevention is not surgical but rather is systemic, such as finding ways to block the carcinogens or do something to reverse the damage to the genes. This option should only be exercised after much medical consultation, counseling and soul searching on your part. "Cancer phobia" cannot be cured with a prophylactic mastectomy and needs to be addressed with psychotherapy rather than a surgery that very well may not be needed.