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Prophylactic surgery for family history?

Page last modified on: August 1, 2008
Question from KF: I am considered to be in a high-risk category as I have two first-degree relatives who had breast cancer. One is a survivor and the other passed away from metastatic breast cancer. There is also a family pattern for breast/ovarian cancer. We have been genetically tested and do not have the BRCA1 or BRCA2 mutations. Should I consider prophylactic mastectomy? What are some other ways to reduce my risk?
Answer —Lynn Hartmann, M.D.: Your question is very important because many women with a family history such as yours who are tested do not have an abnormality in BRCA 1 or 2. Our current technology cannot find all the mutations in these genes. Or perhaps there are other susceptibility genes that we cannot yet test for. A decision to proceed with prophylactic surgery is complex and very much an individual preference type of decision. It depends in part on ease of your breast exam and the density of your breast tissue on mammography. Breast MRI may also be an option.

The goal of surveillance is to pick up any cancer that might develop as early as possible. There is no one recommendation for prophylactic surgery in women such as yourself. You may be a candidate for a chemotherapy prevention study that is currently ongoing. Or tamoxifen is also a risk-reduction strategy, depending on your preference and other health issues.

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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