Prophylactic mastectomy and breast cancer risk
Bilateral prophylactic (PRO-fih-LAK-tik) mastectomy is the removal of both breasts to prevent breast cancer. Studies suggest prophylactic bilateral mastectomy can lower the risk of breast cancer in women at high risk by 90 percent or more [231-238]. And, the procedure may add three to five years to the lifespan of a 30-year-old woman who carries a BRCA1 or BRCA2 gene mutation [232,239-240].
Some BRCA1 or BRCA2 carriers and women with a strong family history choose this option because it eases their worries about getting breast cancer. It may also make them feel they have done all they can do to prevent breast cancer.
The pros and cons of prophylactic mastectomy
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 [232-238]. A mastectomy is not able to remove all of a woman's breast tissue. This means there is always a small chance breast cancer could occur in the remaining tissue.
The benefits of prophylactic mastectomy seem to be greatest in younger women. Younger women have more years of life ahead than older women. For women 60 years and older, the gain in lifespan after a prophylactic mastectomy is small.
Prophylactic mastectomy has some risks, including problems from surgery. And, in addition to the emotional impact of losing both breasts, some women have body image issues that can affect how they feel sexually [238,241-243]. Talking to a health care provider or counselor, or joining a support group, can help address these issues.
Learn more about sexuality and intimacy after breast surgery.
Learn more about support groups.
Breast reconstruction after prophylactic mastectomy
If you choose to have a prophylactic mastectomy, you may wish to have breast reconstruction at the same time as the mastectomy or at a later time. Learn more about breast reconstruction.
At this time, there is no federal law requiring insurance providers to cover prophylactic mastectomy. Coverage varies state to state. To find out whether 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.
Women with a BRCA1 or BRCA2 gene mutation are at higher risk of both breast cancer and ovarian cancer. One option for reducing risk is prophylactic oophorectomy (surgical removal of the ovaries). This procedure [239,244-252]:
- Lowers the risk of ovarian cancer by 70 to over 90 percent
- Lowers the risk of breast cancer by 40 to 70 percent
The National Comprehensive Cancer Network (NCCN) recommends women from families with hereditary ovarian cancer syndromes, including BRCA1 and BRCA2 carriers, have oophorectomy between ages 35 and 40 (or after childbearing is complete) .
Support for women with hereditary breast and/or ovarian cancer
Some support groups are tailored for BRCA1 and BRCA2 carriers and those with BRCA-related cancers. Our Support section offers a list of resources to help find a local or on-line support group. For example, the organization FORCE has on-line support for women with BRCA1 and BRCA2 mutations and those affected by hereditary breast and ovarian cancer. Our Helpline1-877 GO KOMEN (1-877-465-6636) can also provide support for BRCA1 and BRCA2 carriers and those considering genetic testing.