Monday Myths: Preventative mastectomy eliminates the risk for breast cancer

Does preventative mastectomy eliminate the risk for breast cancer?

The incidence of breast cancer among all women is about 11%.  Some families have a higher incidence from generation to generation.   Genetic testing has recently become available to help assess risk in these families.  Positive identification of either the BRCA1 or BRCA2 (BReast CAncer) genes puts a woman’s risk for breast cancer at nearly 80%.

The threat of such a serious disease can be terrifying.   For women at risk, early detection is extremely important, as are frequent mammograms and MRI exams.   Diligent breast self-exams, combined with yearly physician consultation are also the cornerstones of early detection.  Of course, early detection and treatment provides the greatest chance for a cure for anyone diagnosed with breast cancer.

But what can be done to reduce the risk of developing breast cancer if you are gene positive?  

Some medications, such as  Tamoxifen, can reduce the risk.  A more definitive solution involves surgery.  Prophylactic mastectomy  or preventative breast removal is certainly a choice in these situations.  However, this surgery is severe and often deforming.   It is sometimes combined with immediate reconstruction, but the results pose an adjustment in body image.

Is the peace of mind that comes with significantly reducing the 80% risk of breast cancer worth it?  It is a personal decision.  Removal of the breast, including the nipple, can considerably reduce the risk of developing breast cancer to below 1%.  If the nipple is spared, in what is known as  subcutaneous mastectomy, the risk of breast cancer is about 5%.  Sadly, the risk of developing breast cancer cannot be totally eliminated yet, because it is impossible to remove all of the breast tissue surgically.  Even with the dramatic reduction in breast cancer risk, breast self-exam and physician follow up is always necessary.

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