Prophylactic Mastectomy

Abstract

W Abstract: Prophylactic mastectomy may be an appropriate treatment for several groups of women. These groups include women with a strong family history of breast cancer, especially those with known BRCA mutations, women with high risk pathologic changes found on previous breast biopsies, women with an immobilizing fear of developing breast cancer, and women with contralateral breast cancer. The effectiveness of prophylactic mastectomy is controversial although recent data suggests a possible gain in life expectancy for high risk women undergoing bilateral prophylactic mastectomy. Each woman should have a thorough discussion with her treatment team, which should include a oncologic surgeon, plastic surgeon, psychologist, and genetic counselor, to realistically assess her risk due to family history, genetic mutations, or high risk pathologic findings, as well as the expectations and limitations of prophylactic mastectomy. W Key Words: prophylactic mastectomy, high risk, preventive surgery, breast cancer genetics ne of the most controversial surgical procedures 0 today is the prophylactic mastectomy, which removes the breast when there is no known disease present in the hope of preventing future breast cancer. Much of the controversy has revolved around the question of how much the risk is reduced and for whom is Address all correspondence and reprint requests to: Rache M. Simmons, M.D., 428 East 72nd Street, New York, NY 10021, U.S.A. 0 I997 Bluckwell Scwnce Inc., 1075-122X/~7/$10.50/0 rhp Breust /oi4rtztil. Volume 3, Nicmher 6, 1997 372-379the procedure appropriate. There are two groups of women who may consider this procedure: those who have breast cancer in one breast and choose to have the opposite normal breast removed, a contralateral prophylactic mastectomy (CPM); and those who do not have breast cancer and choose to have both normal breasts removed, bilateral prophylactic mastectomies (BPM). The majority of women who consider BPM are those a t increased risk of developing breast cancer. This group includes those with a strong family history of breast cancer or those with high-risk lesions such as lobular neoplasia (lobular carcinoma in situ) or atypical ductal/lobular epithelial hyperplasia observed on a previous biopsy. Recently, the discovery of the BRCA-1 and BRCA-2 breast cancer genetic mutations and the availability to test for the presence of these mutations, will lead to a significant new group of women considering this procedure. Another group of women that may consider BPM are those with an incapacitating fear of developing breast cancer, such that it adversely affects their quality of life. For women considering prophylactic mastectomy it is a complex risk:benefit ratio. The potential benefit depends on the risk of breast cancer, the outcome if cancer were to occur, the surgical procedure and its complications in relation to potential benefits of risk reduction. Some women are unwilling to accept close follow-up surveillance with the hope of early detection as their defense against breast cancer ...

Breast Cancer Prevention by Antiestrogens

“…The end of the twentieth century has been marked by the demonstration that an antiestrogen can delay, and perhaps prevent, the onset of breast cancer in women at risk for the disease. Until now the only options available to women at increased risk for breast cancer have been close surveillance 1 or prophylactic bilateral mastectomy 2,3…”

“…The end of the twentieth century has been marked by the demonstration that an antiestrogen can delay, and perhaps prevent, the onset of breast cancer in women at risk for the disease. Until now the only options available to women at increased risk for breast cancer have been close surveillance 1 or prophylactic bilateral mastectomy 2,3 Based on the development of tamoxifen by Walpole over 30 years ago, as an antifertility drug, and the discovery of the estrogen-receptor by Elwood Jenson, the initial pioneering work by Craig Jordan 4,5 showed that this drug could prevent mammary carcinoma in rats. It was also observed that carcinogen-initiated rat mammary epithelial cells were rendered into a resting (G0) phase by tamoxifen.…”