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Heading Breast Cancer Off at the Pass


"If a woman has a family history of ... breast cancer and ovarian cancer and so is also at risk for ovarian cancer, she could have the ovaries removed," says David Euhus, MD, an assistant professor of cancer surgery at University of Texas Southwestern Medical Center at Dallas. "This lowers her risk of breast cancer by 47%. Women are often more willing to do this then to sacrifice a breast."

Euhus says that when his team assesses a woman for breast cancer risk factors, they use a number of variables such as which relatives had breast or ovarian tumors, at what ages the cancer developed, if and when the relatives died from the disease.

"We're very [number] oriented over here," he tells WebMD. "Only half of the generation in which the bad gene is running will ever get breast cancer. But if we're coming up with a 60, 70, 80% risk after we run the numbers through the computer, then [preventive] mastectomy is something they might want to consider."

However, Timothy Rebbeck, PhD, University of Pennsylvania associate professor of epidemiology, says that not enough is known about the part preventive mastectomies play in reducing breast cancer risk. He and his colleagues are currently conducting a study to compare the rates of breast cancer in women who decide to undergo the operation vs. those who don't.

"It is relevant to high risk women, but it may not be necessary," he tells WebMD. Still, he adds that preliminary results of his research are showing a significant risk reduction in those who have the operation.

"But we have to determine how much the risk reduction is and whether it balances out the [psychological and social] factors" of losing a breast, says Rebbeck.

"The reasons some people give for undergoing [preventive] mastectomy is that they are cancer phobic, and justifiably, because they have seen a family member suffer and die," he says. "But the larger group now seems to be those who decide not to have it."

This may be cultural, Rebbeck relates, noting that it's a very common procedure in the Netherlands but almost unheard of in Germany and France. He agrees with Euhus that removing the ovarian tissue may be more effective for some patients and have the additional benefit of not removing the breasts.

Rebbeck adds that the University of Pennsylvania study, which is looking only at women with the genetic defects, may be completed in about a year. At this point, it's too early to hazard a guess about what their results will yield on effectiveness of the preventative surgery.


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