Breast cancer is the most common cancer diagnosed in American women, says the Breast Cancer Research Foundation.

While breast cancer can affect just about any woman (as well as men), certain women are at higher risk for developing breast cancer than others. Such women include those with a family history of breast cancer and/or the presence of genetic markers called BRCA1 or BRCA2 gene mutations, according to the Bedford Breast Institute. Those women have a lifetime risk of up to 87% for getting breast cancer and 53% for developing ovarian cancer.

While these two genetic markers are the leading genes with the highest breast cancer predisposition, there are several other genetic markers important to identifying risk as well, stated Dr. Lisa Lai, breast surgeon from Upstate Cancer Center and Upstate’s Comprehensive Breast Care Program.

Besides genetic markers, other risk factors include the presence of dense breast tissue, exposure to radiation at an early age, and having already had cancer in one breast.

What is prophylactic mastectomy?

In instances when breast cancer risk is particularly high, women may opt to undergo prophylactic mastectomy, also called preventative mastectomy. This is the surgical removal of the breasts with the intent to dramatically reduce the risk of developing breast cancer.

“The goal is to select a patient that’s at high enough risk that undergoing the surgery is worthwhile. So it’s looking at the whole patient, their testing, and their family history to say that undergoing this rather drastic surgery, or taking this rather big step forward, is worth it,” Lai explained.

Rate of risk reduction

The Mayo Clinic says prophylactic mastectomy reduces the risk of developing breast cancer by 90 to 95% among women with BRCA gene mutations. It is roughly the same risk reduction for women who already have had breast cancer or have a strong family history of the disease and then have a breast removed.

Studies indicate that preventative mastectomy of the unaffected breast (called contralateral prophylactic mastectomy) in cases when breast cancer occurred in the other breast, when no genetic mutations or hereditary risk factors are present, has little to no effect on overall survival rate. This is a surgery only for those with very high risk.

Why isn’t risk reduced completely?

Not all breast tissue can be removed during a prophylactic mastectomy. That is because breast tissue can sometimes be found in the chest, armpit, skin, above the collarbone, or on the upper part of the abdominal wall, states the Mayo Clinic. Although risk reduction is significant after mastectomy, that risk cannot be eliminated entirely.

Risks associated with
prophylactic mastectomy

There are some risks associated with prophylactic mastectomy, both during the procedure and afterwards. BreastCancer.org says bleeding or infection, fluid collecting under the scar, delayed wound healing, scar tissue formation, loss of sensation in the chest, and complications while being put under anesthesia are all possible.

Added risks include chronic pain and dissatisfaction with the chest or other body imaging concerns, Lai said.

Women are urged to carefully consider the pros and cons before opting for the surgery.

Lai stated, “It comes down to educating the patient and giving them a lot of information and helping them make a personal choice. We have patients who we discuss this with, but they’re not interested. And the alternative to that is close, careful screening, usually with mammograms and possibly MRI each year. But for that high risk patient, doing the prophylactic mastectomy is the most powerful way we can reduce their risk of breast cancer. It doesn’t make the risk of breast cancer zero, but it greatly reduces the risk that may have started out like up to 80% lifetime chance of developing a breast cancer and take it down to under 5%, for example.”

Alternatives

Prophylactic mastectomy is only one option for women at high risk for developing breast cancer. Some alternatives include:

• Ultrasounds, physical exams, and mammograms every six months to yearly.

• Medication that can reduce risk of developing breast cancer.

• MRIs in addition to mammograms.

• Surgery to remove the ovaries, which can decrease both the risk of breast and ovarian cancers.

Other considerations

Making the decision to get a prophylactic mastectomy doesn’t stop there, Lai explained. Next is the topic of reconstruction and whether it’s something the patient would like to pursue or not, and how it’s going to be done.

Reconstruction is performed by a plastic surgeon “either doing an implant-based reconstruction or a tissue-based reconstruction where they take the patient’s own body tissue and rotate it into the breast space to make a reconstructed breast,” Lai explained.

She continued, “Those are a lot of important decisions to make, but fortunately, the patient who’s having a prophylactic mastectomy has time to think about it. So it’s not a decision that’s made overnight, but usually after a lot of careful thought and consult and speaking to people in the community and people they know. For example, a lot of these patients have their own support groups to support each other and share their experiences.

“So in contrast to somebody who has cancer and has to make a quick surgery decision, somebody who’s thinking about prophylactic mastectomy is usually gathering information and processing it a bit more slowly and giving it a little more thought.”

All of these decisions should be made with an expert in a specialized center, Lai emphasized.

Metro Newspaper Service contributed to this report.