Prophylactic mastectomy and oophorectomy for BRCA mutation carriers – pro

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

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