Prophylactic Surgery to Reduce Breast Cancer Risk: A Brief Literature Review

Abstract

Prophylactic mastectomy reduces the likelihood of developing breast cancer among women at heightened risk for breast cancer, but at significant personal cost. Women at increased breast cancer risk on the basis of hormonal history, family history and/or genetic mutation carrier status may consider bilateral prophylactic mastectomy with or without reconstruction to reduce their cancer risk and/or decrease their chances of cancer mortality. Women having received mastectomy as treatment for breast cancer may request contralateral mastectomy to decrease the chances of developing a second breast primary. The potential oncologic value of these procedures must be weighed carefully on a case-by-case basis against the operation's physical and psychological morbidity. The purpose of this literature review is to provide a practice-oriented summary of recent clinical studies attempting to address the relative risks and benefits of preventive surgery for breast cancer. Data are included regarding the psychological factors surrounding patient selection and quality of life outcomes, which become the cornerstone of patient satisfaction and acceptance. Taken together, these data support the Society of Surgical Oncology position statement regarding the proper application of prophylactic surgery for breast cancer.

Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

“…15,16 It is the only known method of accomplishing a risk reduction rate of greater than 95%. 10 In this study, 38.8 % and 49.1% of women in rural and urban areas respectively were willing to accept bilateral mastectomy, connoting that four in ten of women who reside in rural areas and five in ten of those who reside in urban areas were willing to accept preventive bilateral mastectomy as a risk reducing strategy if found to be at high risk. This is in agreement with findings from a study conducted among Austrian women at high risk in which about three in ten (29%) considered preventive mastectomy.…”

“…8,9 Existing data suggest, that preventive mastectomy may significantly prevent or reduce the risk of breast cancer by about 100% in moderate-risk women and 90-95% in high-risk women. 10 These figures far exceeds reduction achieved by other preventive measures such as Clinical Breast Examination (CBE) which reduce the risk by 40-45% and mammography by 45-67%. 11,12 In the light of the above, the promotion of preventive mastectomy for women at high risk has a potential to reduce breast cancer related morbidity and mortality among women at high risk in both rural and urban areas.…”

Principles of Surgical Therapy in Oncology

“…For women with BRCA1 or BRCA2 mutations, the lifetime probability of breast cancer is between 40% and 85%. [41][42][43] Because mastectomy cannot remove all breast tissue, women can expect a 90% to 94% risk reduction with prophylactic surgery. 44 Schrag et al calculated the estimated gain in life expectancy after prophylactic surgery versus no operation in women with either a BRCA1 or BRCA2 mutation and found a 30-year-old woman would be expected to gain 2.9 to 5.3 years of life, depending on her family history.…”

Contralateral risk-reducing mastectomy in young women

“…Contralateral risk-reducing mastectomy consists in the surgical removal of the contralateral breast to reduce the risk of breast cancer there [1].…”