Email a Friend
Print ArticleBreast Cancer Health Center
Breast Cancer and Preventive Mastectomy
In hopes of avoiding future disease, some women at very high risk of developing breast cancer elect to have both breasts surgically removed, a procedure called bilateral prophylactic mastectomy or preventive mastectomy. The surgery aims to remove all breast tissue that potentially could develop breast cancer. Preventive breast cancer surgery also may be considered if a woman has already had breast cancer and is therefore at increased risk for developing the disease again in either breast. A preventive mastectomy might also be considered if the woman has the BRCA1 or BRCA2 genetic mutation that increases risk of breast cancer.
Is Prophylactic Mastectomy Effective at Preventing Breast Cancer?
A recent study suggests that prophylactic mastectomy may reduce the risk of breast cancer by as much as 100% if there is a family history or genetic mutation. However, results vary widely for other reasons. In some studies, women had prophylactic mastectomies for a variety of reasons, such as pain, fibrocystic breast disease, dense breast tissue, cancer phobia, or a family history of breast cancer. Some women still developed breast cancer even though they had their breast tissue removed. But in most studies, patients did not develop breast cancer after prophylactic mastectomy. However, many of these patients would not have been considered high risk for developing cancer.
Some experts have argued that even for high-risk women, prophylactic mastectomy is inappropriate because not all breast tissue can be removed during a surgical procedure. To understand why, we need to know what comprises breast tissue and where cancer originates.
Where Does Breast Cancer Form?
Breast cancers may develop in the glandular tissue of the breast, specifically in the milk ducts and the milk lobules. These ducts and lobules are located in all parts of the breast tissue, including tissue just under the skin. The breast tissue extends from the collarbone to the lower rib margin, and from the middle of the chest, around the side and under the arm.
In a mastectomy, it is necessary to remove tissue from just beneath the skin down to the chest wall and around the borders of the chest. However, even with very thorough and delicate surgical techniques, it is impossible to remove every milk duct and lobule, given the extent of the breast tissue and the location of these glands just beneath the skin.
Who Should Have a Preventive Mastectomy?
Does this mean that every patient should consider breast cancer prevention surgery? The answer is clearly no. The decision to proceed with preventive mastectomy is an individual decision. Such factors as an estimation of individual breast cancer risk, the ability to monitor the patient for early breast cancer and, most importantly, the patient's concerns and feelings need to be considered in making this decision.
According to the American Cancer Society, only those women who are at very high risk of breast cancer should consider surgery. This includes women with one or more of the following risk factors:
- mutated BRCA genes.
- previous cancer in one breast and a strong family history of breast cancer.
- history of lobular carcinoma in situ (LCIS).
Preventive mastectomy should only be considered after you've received the appropriate genetic and psychological counseling to discuss the psychosocial impacts of the procedure.
WebMD Medical Reference
Breast Cancer Guide
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
October is National Breast Cancer Awareness Month, and a new study reveals why a high number of women with the disease still prefer to have the entire breast surgically removed instead of just the tumor. It's not always because doctors recommend it.
