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Breast Cancer

Surgery for breast cancer prevention is the removal of healthy breasts to reduce the risk of breast cancer. This is known as preventative mastectomy, risk-reducing mastectomy, or prophylactic mastectomy. Women with a high risk of breast cancer may consider this option to avoid getting the disease. However, because it is impossible to remove 100% of the breast tissue, a small risk of developing breast cancer may still exist.

The average woman has about a 12% risk of developing breast cancer over her lifetime. However, some women have genetic mutations, most of them inherited, that are associated with more than a 50% lifetime chance of getting breast cancer. Some of these mutations are found in the BRCA1, BRCA2, PTEN, P53, CDH1, and PALB2 genes. In addition, women who received radiation treatments before age 30 to the front of their chests to treat other cancers (for example Hodgkin’s lymphoma) may have a similarly increased risk of developing breast cancer. Women who have a greater than 50% lifetime risk of developing breast cancer should speak to their clinician about the possibility of surgically removing both healthy breasts. Also, women who have had breast cancer in one breast may consider removing the other healthy one to lower their chance of developing another cancer.

There are some women who have mutations in other genes, for example the ATM and CHEK2 genes, that place them in a moderately increased risk (25 to 50%) of breast cancer. Preventative mastectomy is usually not necessary in these women even if they already have had cancer in one breast. Instead, depending on family history, their doctors may suggest close frequent screening (mammography and breast MRI) and medications to lower their risk.

In terms of cosmetic outcomes, breast cancer surgery has come a long way. There are three surgical options. The first is simple (total) mastectomy, which removes the nipple-areola complex (which is sometimes temporarily transplanted to the abdominal wall for reuse during breast reconstruction), the breast tissue, and the overlying skin. Skin-sparing mastectomy involves removal of the nipple-areola area and breast tissue while preserving most of the overlying skin. The third option is nipple-sparing (subcutaneous) mastectomy, which is performed by making an incision below the breast, removing the breast tissue while sparing both the nipple-areola area complex and the skin over the breast.

High-risk women who do not want surgery can have annual breast cancer screening which includes MRI scanning starting at age 25, with annual mammography starting at age 30, and then alternating MRI with mammography every six months after age 30. High risk women may also want to consider medications, such as Tamoxifen, that may lower their breast cancer risk. Surgical complications can include wound problems, infections, bleeding, and the occasional need for additional surgery to treat complications. Also, some women may develop emotional issues, abnormal sensations on the chest wall, or problems with body image and sexual relationships after these procedures. Obviously, extended consultations with clinicians plus discussions with family are necessary before deciding on surgery to remove healthy breasts.

For more information go to the US National Library of Medicine at:

www.medlineplus.gov/ency/article/002919.htm  

Please direct questions and comments to editor@rockawaytimes.com

By Peter Galvin, MD

 

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