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
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