Meaning of prophylactic mastectomy: It is the surgical removal of a non-cancerous breast with the intention of preventing onset of breast cancer in that breast.
The question of prophylactic mastectomy comes in two clinical situations:
1. Those women who have been diagnosed with cancer in one breast and who are concerned of a new cancer coming up in the opposite breast and thus explore the possibility of removing this breast as prevention. This is called contra-lateral prophylactic mastectomy (the word contra meaning the opposite side).
2. Those women who do NOT have a diagnosis of cancer but who have high risk factors for developing breast cancer. Such patients may explore the possibility of removing both breasts to prevent the onset of cancer. This is called bilateral prophylactic mastectomy (the word bilateral meaning both sides).
Let us consider the first situation of contra-lateral prophylactic mastectomy in women already diagnosed with cancer in one breast. The following are some of the situations where this decision may be appropriate.
1. Diagnosed at age 45 or younger, regardless of family history.
2. Diagnosed at age 50 or younger and EITHER of the following:
- at least one close blood relative with breast cancer at age 50 or younger.
- at least one close blood relative with epithelial ovarian, fallopian tube, or primary peritoneal cancer.
3. Diagnosed with two breast primaries (includes bilateral disease or cases where there are two or more clearly separate ipsi-lateral primary tumors) when the first breast cancer diagnosis occurred prior to age 50,
4. Diagnosed at age 60 or younger with a triple negative breast cancer.
5. Diagnosed with two breast primaries when the first breast cancer diagnosis occurred prior to age 50.
6. Personal history of ovarian, fallopian tube, or primary peritoneal cancer.
7. Close male blood relative with breast cancer.
8. Women of Ashkenazi Jewish, Icelandic, Swedish, Hungarian, or Dutch descent.
9. Development of invasive lobular or ductal carcinoma in the contra-lateral breast after electing surveillance for lobular carcinoma in situ of the ipsi-lateral breast..
10. Lobular carcinoma in situ confirmed on biopsy.
11. Lobular carcinoma in situ in the contra-lateral breast.
12. Diffuse indeterminate micro-calcifications or dense tissue in the contra-lateral breast that is difficult to evaluate mammographically and clinically.
Bilateral prophylactic mastectomy may be considered in women who have the following situations:
1. Those with confirmed BRCA1 or BRCA2 genetic mutation.
2. Those with close blood relative with a known BRCA1, BRCA2 mutation.
3. First or second-degree blood relative meeting any of the above criteria for individuals with a personal history of cancer.
4. Third-degree blood relative with two or more close blood relatives with breast and/or ovarian cancer (with at least one close blood relative with breast cancer prior to age 50).
5. Those with a history of treatment with radiation to the chest.
6. Those with atypical ductal or lobular hyperplasia, especially if combined with a family history of breast cancer.
7. Those with dense breasts that are difficult to evaluate through mammograms and breast exams. Those with several prior breast biopsies for abnormalities with a strong concern about breast cancer risk.
The decision to proceed with prophylactic mastectomy should be taken very seriously because of its irreversible nature and its major implications on the physical and psychological welfare of these women. There are a number of non-surgical options that are available to lower the risk of breast cancer in the situations outlined above. It is strongly urged that women exploring this difficult decision discuss with expert physicians regarding less radical, non-surgical options.
Dr. Kumar is a board certified Radiation Oncologist who is co-founder of a private practice group in Florida. He has over 17 years experience dealing with cancer patients including several members in his own family who have been afflicted by this disease.
His philosophy of managing patients is through a unique holistic approach that takes into account the wishes and needs of patients and their families. He believes that any battle is won at the level of the mind first before the body goes into action to win the war. His website http://curingcancerofthemind.com/ reflects this philosophy.
He is always available to help any patient with questions regarding cancer and radiation therapy and can be reached at 772 293 0377.
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