Cancer Treatment Today » Inherited Breast Cancer http://cancertreatmenttoday.org Knowledge is Power Thu, 21 May 2026 12:55:14 +0000 en-US hourly 1 Prophylactic mastectomy and oophorectomy for BRCA mutation carriers – pro http://cancertreatmenttoday.org/prophylactic-mastectomy-and-oophorectomy-for-bra-mutation-carriers-pro/ http://cancertreatmenttoday.org/prophylactic-mastectomy-and-oophorectomy-for-bra-mutation-carriers-pro/#comments Fri, 11 Oct 2013 16:31:52 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=11538 Prophylactic bilateral mastectomy is the surgical removal of both breasts to help prevent breast cancer. Prophylactic mastectomy is a controversial procedure among members of the medical community. Based on recent scientific findings that show prophylactic mastectomy to be effective at preventing breast cancer, some physicians think that it is  sometimes recommended even without evidence of genetic causation.  According to the American Cancer Society Board of Directors, “only very strong clinical and/or pathological indications warrant doing this type of ‘preventive operation.” BRCA positivity is generally thought to be an strong indication for it.

A recent article in the Journal of American Medical Association suggests that in BRCA positive patients there is a benefit to bilateral prophylactic mastectomy. Prophylactic surgery  reduced the high risk of breast and ovarian cancer among BRCA mutation carriers and improved survival, researchers affirmed. Similarly, all-cause mortality dropped from 10% without salpingo-oophorectomy to 3% with it (hazard ratio 0.40, 95% confidence interval 0.26 to 0.61). Even before theis information, ESMO was recommending bilararl mastectomy and oophorectomy. The American College of Obstetricians and Gynecologists’ guidelines on “Hereditary breast and ovarian cancer syndrome” (ACOG, 2009) stated that “risk-reducing salpingo-oophorectomy should be offered to women with BRCA1 or BRCA2 mutations by age 40 or after the conclusion of child-bearing”.

Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;11:CD002748.

J. Balma, BRCA in breast cancer: ESMO Clinical Practice Guidelines, Ann Oncol (2010) 21 (suppl 5): v20-v22.

Easer an j, Lessons learned from genetic testing. JAMA. 2010 Sep 1;304(9):1011-2.

Susan M. Domchek; Tara M. Friebel; Christian F. Singer; D. Gareth Evans; Henry T. Lynch; Claudine Isaacs; Judy E. Garber; Susan L. Neuhausen; Ellen Matloff; Rosalind Eeles; Gabriella Pichert; Laura Van t’veer; Nadine Tung; Jeffrey N. Weitzel; Fergus J. Couch; Wendy S. Rubinstein; Patricia A. Ganz; Mary B. Daly; Olufunmilayo I. Olopade; Gail Tomlinson; Joellen Schildkraut; Joanne L. Blum; Timothy R. Rebbeck. Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality. JAMA, 2010; 304 (9): 967-975

Laura Esserman; Virginia Kaklamani. Lessons Learned From Genetic Testing. JAMA, 2010; 304 (9): 1011-1012

]]> http://cancertreatmenttoday.org/prophylactic-mastectomy-and-oophorectomy-for-bra-mutation-carriers-pro/feed/ 0 Prophylactic Mastectomy in Carriers of BRCA Mutation – pro http://cancertreatmenttoday.org/prophylactic-mastectomy-in-carriers-of-brca-mutation/ http://cancertreatmenttoday.org/prophylactic-mastectomy-in-carriers-of-brca-mutation/#comments Mon, 20 Aug 2012 18:27:47 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=4696 Prophylactic total or simple mastectomy, not subcutaneous mastectomy, for patients at high risk of breast cancer is a difficult issue in that it involves the determination of risk in an individual patient, a separate determination of what level of risk is high enough to justify the extreme choice of prophylactic mastectomy, and assurance from scientific studies in the medical literature that this procedure does result in a reduction of breast cancer occurrence. It is, however, generally assumed that the high risks of breast cancer in women with BRCA positivity justifies mastectomy and other risk reduction measures. Even the usually parsimmonious European EMO guideline of 2011 says: “It is the most effective strategy available for risk reduction of breast cancer in mutation carriers [III, B], although no benefit in survival has been demonstrated and many women do not find this strategy acceptable for cosmetic reasons. Contralateral prophylactic mastectomy is an option to consider in BRCA mutation carriers with early breast cancer undergoing unilateral mastectomy [III, B].” Other guidelines echo these recommendations. Other options for risk reduction include hormonal prophylaxis and/or oophorectomy as well as intensive surveillance.

  • Association of Breast Surgery at BASO; Association of Breast Surgery at BAPRAS; Training Interface Group in Breast Surgery; Baildam A, Bishop H, Boland G, et al. Oncoplastic breast surgery — a guide to good practice. Eur J Surg Oncol. 2007;33 Suppl 1:S1-S23.
  • Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;11:CD002748.
  • J. Balmaña, O. Diez, I. Rubio, M. Castiglione5 and On behalf of the ESMO Guidelines Working Group
    BRCA in breast cancer: ESMO Clinical Practice Guidelines Ann Oncol (2010) 21 (suppl 5): v20-v2

Read the Layperson version here.

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