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Prophylactic mastectomy to reduce risk?

Page last modified on: October 7, 2008
Question from LMG: I am 39, BRCA1 positive, and currently undergoing MRI surveillance every six months. My 47-year-old sister died of breast cancer last month. Am I being foolish not to have prophylactic removal of my breasts? I had my ovaries out at 36 to reduce risk already. Should I start tamoxifen?
Answers —Beth DuPree, M.D., F.A.C.S.: The decision to do prophylactic surgery is often a very difficult decision to make. Prophylactic mastectomy does not remove all risk of developing breast cancer but can significantly reduce the risk of developing an invasive cancer in the future.

A very thorough discussion should take place between you the patient, your surgeon and potentially your oncologist to help you come to a decision about what is absolutely best for you. There is no right or wrong answer, and depending upon what your goals are through this process you should be able to come up with a plan of action for your future surveillance and/or risk reduction.

Tamoxifen can certainly help to decrease the risk of developing an estrogen-receptor-positive tumor, but there are no foolproof methods to keep you from developing a breast cancer. Therefore, as I said before, work with your physician to determine what is best for you.
Lynn Hartmann, M.D.: Issues that can help with this decision include the ease of your breast exam and the density of your breast tissue. Having had your ovaries removed should provide some risk reduction. I would reiterate what Dr. DuPree has said, that this is very much an individual decision.

On Wednesday, February 15, 2006, our Ask-the-Expert Online Conference was called Risk Reduction. Lynn C. Hartmann, M.D. and moderator Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about a variety of topics such as screening with mammograms, MRIs, and ultrasounds; breast biopsies; lifestyle changes that make a difference; and making hard decisions about prophylactic surgeries.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Lynn C. Hartmann, M.D.Lynn Hartmann, M.D. is a professor of oncology at the Mayo Clinic and associate director for education of the Mayo Clinic Cancer Center.

Beth Baughman DuPree, M.D., F.A.C.S.Beth Baughman DuPree, M.D., F.A.C.S. is a general surgeon. Her clinical practice is located at Holy Redeemer Hospital and St. Mary Medical Center.

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