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Breast Removal Slashes Risk of Cancer in High-Risk Women

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WebMD Health News

April 3, 2000 (San Francisco) -- Cutting off a woman's breasts to save her life appears to work, says a cancer researcher from the Mayo Clinic.

For women who live in daily terror of breast cancer because they have seen the disease claim grandmothers, mothers, and sisters, removing both breasts may be an option, says Lynn Hartmann, MD, professor of medicine at the Mayo Clinic. The Clinic serves as a national referral center for women with breast cancer.

In the years 1960 through 1993, 425 women who had a family history of breast cancer went to the Mayo Clinic to have their breasts removed before they even got cancer. Hartmann and her colleagues published a study last year that found that these women reduced their risk of breast cancer by 90%. Now, she is following up that study by looking at the effect of the surgery on women who not only have a family history but actually are carriers of the so-called breast cancer genes, actually genetic mutations called BRCA1 or BRCA2.

Searching the records of the women who underwent the surgery, called prophylactic (preventive) bilateral mastectomy, Hartmann found 28 women who have the genetic mutation. She says that 17 women have a type of mutation that is known to cause cancer, and 11 have mutations that may or may not cause cancer.

But not one of the women in more than 15 years of follow-up developed breast cancer, meaning a cancer that would occur in the chest wall or tissue remaining after the breasts were removed. She says that given the presence of the mutations, almost 11 would have been expected to develop cancer during the 15 years. Because Hartmann and her colleagues don't have complete blood tests from one woman, the reduced risk is 90% not 100%.

While those findings are very impressive, Hartmann tells WebMD, "This is not a procedure we would recommend."

Hartmann presented the results at a meeting of cancer researchers here.

Asked what this finding means to women, Hartmann tells WebMD that she does not think that having both a family history and the genetic mutation combine to make a more compelling case for the surgery.

Hartmann says there are other options for these women such as close follow-up and medication. She adds that surgery is not the choice most women make. A study by researchers at Johns Hopkins University in Baltimore found that when 160 women with family histories of breast cancer were asked about prophylactic mastectomy "two-thirds of them said they wanted to discuss it, but only 14 or 10% went on to have the surgery. That's about the rate that we see."

She says, however, that the surgery remains controversial. "Opponents argue that, as a solution, it is too extreme," Hartmann says. Proponents of the surgery, on the other hand, say, "if it reduces risk, where is the question?" She says that there are many factors that influence a woman's decision to chose the surgery but the strongest is "family. If a woman has a family, has children, she is more anxious to take some action that assures her she will be there for her family."

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