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    Preventive Mastectomy Lowers Cancer Risk

    Study: Preventive Surgery Lowers Breast Cancer Risk by 90% for Women with 'Breast Cancer Genes'


    In his new study, to be published next month in the Journal of Clinical Oncology, Rebbeck finds that BRCA women who also had preventive oophorectomy either before or after double mastectomy fared even better, reducing their six-year breast cancer risk by 95% compared to those who got no surgery at all.

    "This study confirms two prior reports that prophylactic mastectomy is highly effective for preventing breast cancer in women with BRCA mutations," says Noah D. Kauff, MD, FACOG, of Memorial Sloan-Kettering Cancer Center in New York. "The study does not, however, address whether prophylactic mastectomy confers a survival advantage compared to women undergoing intensive surveillance. This and impact on quality of life are the key issues for women with BRCA mutations who are considering the procedure."

    Kauff, a gynecologist and geneticist who specializes in caring for patients with inherited predisposition to cancer, was not involved in Rebbeck's study. While he notes the surgeries can be highly effective, he advises that all women with a personal and/or family history of either breast or ovarian cancer that occurs before menopause consult with cancer genetic counselors to determine their best options. In addition to preventive surgery, they can be treated with intensive surveillance, preventive chemotherapy or drugs such as tamoxifen that counteract estrogen's effects on the breast.

    But most women who opt for preventive mastectomy are satisfied withtheir decision, according to research by Marlene Frost, PhD, RN, of the Mayo Clinic's Women's Cancer Program. In a July 2000 study published in the Journal of the American Medical Association, she found that 70% of 572 women who underwent preventive double mastectomy were satisfied with their decision 14 years later, compared to only 19% who weren't.

    And in a follow-up survey she presented last summer before the American Society of Clinical Oncology, she reported that 83% of women who had one breast removed because of cancer and then chose to have the other breast removed to reduce their risk of developing a second breast cancer were satisfied with that decision more than 10 years later.

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