Prophylactic mastectomy
Bilateral prophylactic (PRO-fih-LAK-tik) mastectomy is the removal of both breasts to prevent breast cancer. Some women with BRCA1/2 mutations or a strong family history may choose this option because it eases their worry about getting breast cancer. It may also make them feel that they have done all they can do to prevent it. Studies suggest that prophylactic bilateral mastectomy can lower the risk of breast cancer in women at high risk by 90 percent or more [199-203]. And, the procedure may add three to five years to the lifespan of a 30-year-old woman who is a BRCA1 or BRCA2 carrier [199,204,205].
A woman at high risk for breast cancer should talk with her health care provider about the pros and cons of prophylactic mastectomy. Prophylactic mastectomy does not completely protect a woman from breast cancer [199-203]. A mastectomy is not able to remove all of a woman's breast tissue. This means that there is always a chance that cancer could occur in the remaining tissue. And, the benefits of prophylactic mastectomy seem to be greatest in younger women. Younger women have more years of life ahead of them than older women. For women 60 years and older, the gain in lifespan after a prophylactic mastectomy is small. Prophylactic mastectomy also has some risks, including problems from surgery and the emotional impact of losing both breasts [206-208].
After at the time of prophylactic mastectomy or at a later time, you may wish to have breast reconstruction. Learn more about reconstructive breast surgery.
At this time, there is no federal law requiring insurance providers to cover prophylactic mastectomy. Coverage varies state to state. To find out whether or not your state has a law requiring coverage for the procedure, visit the State Cancer Legislative Database Program at http://www.scld-nci.net/. You can also check with your insurance provider.
Prophylactic oophorectomy
Women with a BRCA1 or BRCA2 gene mutation are at higher risk of breast cancer and ovarian cancer. One option for reducing risk is prophylactic oophorectomy (surgical removal of the ovaries). This procedure can lower the risk of ovarian cancer by 50 to nearly 100 percent, and it can also lower the risk of breast cancer by nearly 50 percent [204,208-214]. It is recommended that women from families with hereditary ovarian cancer syndromes, including women with a BRCA mutation, have oophorectomy at age 35 to 40 (or after childbearing is complete) [215,216]. For support and more information about hereditary breast and ovarian cancer, visit FORCE.
Updated 11/10/09
