Double mastectomy by choice

Women who are at high risk for developing breast cancer (such as those with the BRCA1 or BRCA2 mutations) may take an unusual step to reduce their risk of breast cancer surgical removal of their breasts. Studies suggest, for women at moderate to high risk, prophylactic mastectomy can reduce the risk of breast cancer by up to 90 percent.

Making the choice to remove both breasts isn’t easy. Most women have a great deal of emotional attachment to their breasts. Even with breast reconstruction, sexual partners may treat a woman differently. Women also face the risks associated with surgery, including pain, infection or development of complications.

Deborah Lindner, M.D., an OB-GYN at Northwestern Memorial Hospital in Chicago, found out she was a carrier of the BRCA1 gene. She says that having the gene is not an automatic sentence of future breast cancer. However, a survey of other female blood relatives found 85 percent of the BRCA1 carriers developed breast cancer. With such a strong link and family history, she decided to have a prophylactic double mastectomy.

Finding a surgeon who was willing to perform the procedure turned out to be a challenge. She was only 33, and many doctors told her she was too young to have the surgery. But with some persistence, she found a surgeon who understood her risk and her concern.

Lindner says women who have a strong family history of breast cancer should consider being tested for genetic mutations that may increase their personal risk for the cancer. Not all families are open about their medical history, so it may take some discussion to get details. If genetic testing indicates the presence of one of the mutations, women should seek advice from a genetic counselor and a surgeon/oncologist who has experience with breast cancer prevention methods.

VIEWER INQUIRY
A resource organization for high-risk women who are considering their options is Bright Pink: http://www.bebrightpink.org

For general information on breast cancer or prophylactic mastectomy:
American Cancer Society, http://www.cancer.org
National Cancer Institute, http://www.cancer.gov
The Society of Surgical Oncology, http://www.surgonc.org