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What factors are important when considering a prophylactic bilateral mastectomy if I cannot do chemoprevention to help prevent breast cancer?
60 years old , biopsy: extenstine ALH with ductal involvement, proliferative fibrocystic disease, had total ductectomies in both breasts due to spontanious discharge( papillomas). Mother is survivor of 24 yrs, had bilateral mast(one prophalactic). Her grandmother & my paternal aunt both had bc. I have CAD with a small area of heart failure from minorheart attack in 2003 due to stress and constriction of coronary artery. On meds for hypertension and have some history of superficial blood clots. I have been advised to try chemoprevention with exemestane. If I can't do it because of heart issues of can't tolerate, are bilateral prophalactic mastectomies an option I should consider?
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ThereseBeversMD (Physician - Family Medicine (Verified) ) - 06 / 27 / 2012
Prophylactic mastectomy is not appropriate for all women at increased risk of breast cancer. Typically, this procedure is recommended for women with a genetic predisposition, such as a mutation in the BRCA1 or BRCA2 genes. Women with a BRCA mutation have as high as 50-80% lifetime risk of developing breast cancer. In the past, prophylactic mastectomy was offered to women with lobular carcinoma in situ (LCIS), a condition that is not cancer or precancer but is associated with a significantly increased risk of developing breast cancer. However, women with LCIS are now best managed with breast cancer risk reducing medications such as tamoxifen or raloxifene.
Prophylactic mastectomy reduces a woman’s risk of developing breast cancer by as much as 90%. While it is a highly effective means of reducing a woman’s breast cancer, it does not prevent all breast cancers. There also risks associated with the procedure. This includes the surgical risk from the prophylactic mastectomy and any reconstruction, if done. There are also long-term psychosexual effects that a woman may experience.
Any woman considering a prophylactic mastectomy should have a very good understanding of her risk of developing breast cancer. For women with a strong family history of the disease, this would likely involve a genetic counseling visit to determine the probability of a genetic mutation in the family and whether genetic testing is recommended. Once a woman understands her risk of developing breast cancer, she should be counseled on all of her options for risk reduction, including healthy lifestyle recommendations, chemoprevention with tamoxifen or raloxifene as well as, for very high risk women, prophylactic mastectomy. Finally, she should have an understanding of the screening tests that would be recommended to detect breast cancer at an early stage, when it is more treatable.
Prophylactic mastectomy reduces a woman’s risk of developing breast cancer by as much as 90%. While it is a highly effective means of reducing a woman’s breast cancer, it does not prevent all breast cancers. There also risks associated with the procedure. This includes the surgical risk from the prophylactic mastectomy and any reconstruction, if done. There are also long-term psychosexual effects that a woman may experience.
Any woman considering a prophylactic mastectomy should have a very good understanding of her risk of developing breast cancer. For women with a strong family history of the disease, this would likely involve a genetic counseling visit to determine the probability of a genetic mutation in the family and whether genetic testing is recommended. Once a woman understands her risk of developing breast cancer, she should be counseled on all of her options for risk reduction, including healthy lifestyle recommendations, chemoprevention with tamoxifen or raloxifene as well as, for very high risk women, prophylactic mastectomy. Finally, she should have an understanding of the screening tests that would be recommended to detect breast cancer at an early stage, when it is more treatable.
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