Prophylactic surgery for triple-negative?


Question from Joanne: I am BRCA1 positive, and being treated for triple negative breast cancer. I am considering bilateral mastectomy and oophorectomy, but what if a treatment for triple negatives is found? Will I have gone through a lot of surgery/disfigurement for nothing?
Answers - Ruth Oratz, M.D., F.A.C.P. There are many issues in this question. The first and most important consideration is the treatment for the breast cancer that has already been diagnosed. The prognosis of your breast cancer, even if it is triple negative, also depends on the size of the tumor and whether or not lymph nodes were involved. You should discuss the issues with your physician in order to have a clearer understanding of the risk of recurrence of this breast cancer. The second set of issues in a patient like you who has a BRCA mutation relates to preventive measures in efforts to avoid a second breast cancer or the possibility of ovarian cancer. It is appropriate for you to question how much or how far to go with these preventive measures. There's not a simple or single answer for everyone in this situation, and decisions are very personal and very complex. You should discuss this with your medical oncologist, your gynecologist, and meet with a genetic counselor if you have not already. Sometimes speaking with other women who have faced this decision can be very helpful. There is a very good web-based group called FORCE, which is an information based website that addresses the concerns, the realities, and the medical information for women who are at increased risk of cancer because of genetic susceptibility. The URL is www.facingourrisk.org.
Beth Baughman DuPree, M.D., F.A.C.S. Specific things to consider: we currently have no fail-safe screening tools for ovarian cancer, and many women after childbearing who are BRCA1 positive and BRCA2 positive opt for or choose prophylactic removal of the ovaries. The decision to choose mastectomy for the treatment of the cancer would also need to look very carefully at how the tumor that you currently have was detected. If the cancer was found early on mammography and if it was image detected on screening studies, the choice of mastectomy may or may not be the appropriate choice. Some women who have cancers that are not found mammographically on screening studies who are BRCA1 and 2 positive feel less comfortable in our ability to detect another cancer in the future at an early stage. These are certainly issues and questions that you should sit down and discuss with your surgeon very carefully in order to help you come up with a plan for your future that will not only appropriately treat the risk of another cancer, but help you to make decisions based upon facts and not upon fear.

On Wednesday, September 20, 2006, our Ask-the-Expert Online Conference was called Open for Your Questions. Ruth Oratz, M.D., F.A.C.P. and moderator Beth Baughman DuPree, M.D., F.A.C.S. answered your questions covering a wide variety of issues relating to breast cancer.

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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