Risk Reduction Options for Breast Cancer
MADISON - Imagine seriously considering a double mastectomy, without any sign of breast cancer. Yet, every day, there are women at high risk for breast cancer who are thinking about it.
"For people at high risk for breast cancer, a risk-reduction mastectomy is one option, but not the only one," said Amye Tevaarwerk, MD, medical oncologist at the University of Wisconsin Carbone Cancer Center. "There is no guarantee that removal of the breasts will prevent breast cancer, but it can cut risk by upwards of 90 percent."
Tevaarwerk says candidates for the surgery generally have known genetic mutations, BRCA1 and BRCA2. But people with a very strong family history of breast cancer might also find themselves considering it.
In addition to the risk-reduction surgery option, patients are also counseled about chemoprevention, the use of drugs to reduce risk. The drugs tamoxifen and raloxifene can reduce risk of breast cancer by up to 50 percent.
Other options include more frequent screening with mammograms and clinical exams, supplemented by magnetic resonance imaging (MRI). Tevaarwerk says women should also ask about clinical trials of new drugs.
There are no comprehensive data on the number of women who are at high risk and opt for risk-reduction surgery. But a 2007 study by Canadian researchers found that 21 percent of 342 women with BRCA1 or BRCA2 genetic mutations but who did not have breast cancer had risk-reduction bilateral mastectomies.
The study also looked at other breast-cancer reduction strategies including risk-reduction ovary removal (54 percent) and chemoprevention or drug therapy (tamoxifen 6 percent; raloxifene 4 percent).
Tevaarwerk says the UW Carbone Cancer Center breast team explains and lays out all the options to patients considering a risk-reduction strategy.
"Before any decisions are made, a team of medical professionals including oncologists, surgeons, radiologists and genetic counselors works with the patient to find the most appropriate approach," said Catherine Beckman, MD, UW Carbone Cancer Center surgeon.
Beckman agrees with Tevaarwerk that risk-reduction breast surgery can be very effective, but it doesn't always prevent breast cancer.
"People need to understand that there can be breast tissue up higher on the chest wall or on the abdominal area. Breast tissue looks like other tissues, so it's easy to miss some," she said.
Reconstruction is usually done right after breast removal. Beckman says both procedures can take 12 hours or more.
With all the factors to consider, Tevaarwerk and Beckman urge women to take time to decide. Beckman says it's not unusual for a patient to take six months to a year to make a decision.
"There are so many things to consider," said Beckman. "A 20-year-old with a known genetic mutation might look at options much differently than a 40-year-old who already has children. Everyone is different, and it boils down to a very personal decision."
Date Published: 10/27/2009