Is prophylactic mastectomy recommended in cases of women who have a family history of breast cancer?

Doctor's Answers (2)

I would strongly suggest genetic counselling and getting yourself checked for hereditary breast cancer based on your family history. But before that I usually advise that my patients have medical and hospitalisation insurance sorted for yourself and your family members.

Even with such a strong family history, it is not given that you may be carrying genes that increase your risk of breast cancer. 

Prophylactic mastectomy ( mastectomy before diagnosis of breast cancer) is an option for those who are carrying genes that put them at very high risk of having breast cancer e.g. BRCA gene mutation. Close surveillance is the other option. 

The clear cut advantage for a prophylactic mastectomy is reduction in worry about breast cancer and NOT breast cancer survival. So this is something that needs a lot more discussion with your doctor. I generally go through the options of either with my patients. It is a long consultation and usually more than one before a decision for a prophylactic mastectomy is made. Then, very often, there are more consultations about reconstruction as the same studies that report on the efficacy of prophylactic mastectomies also report about the negative impact on cosmetic result and sexuality if no reconstruction was performed.

All in all, careful consideration and some tests need to be done before a mastectomy should be considered.

Thank you for the question and best wishes.

Thank you for the question! My answer is quite complex, please allow me to share below. 

For the benefits of readers who might not be familiar with the term, "prophylactic mastectomy" refers to an operation to remove the whole breast, to prevent breast cancer in a well woman. 
 
Angelina Jolie brought this to international attention in 2013, when she herself underwent such an operation. To summarise what is available in the public domain, her mother died from cancer at 56; and was diagnosed at 46. Ms Jolie herself underwent gene testing and discovered that she had a BRCA1 mutation, which highly increases her risk of breast and ovarian cancer.
 
Family history alone should not be cause for alarm. In the local context, many nuclear families may not keep in touch with extended family, so we don't really know which of our blood relatives had cancers. This is important because, for genetic cancers, they tend to follow a pattern
 
If you are aware of such cancers, do speak with your doctor. In my practice, I will do the initial counselling and screening to determine suitability for a genetics test, and refer to one of the few medical oncologists who further specialises in genetic testing and counselling.
The basics of genetics testing should ideally be: for the family members with cancer to have the genetics test first, to see what kind of mutations are present and THEN screen the interested well family members. 
 
There're a few mutations which are well known and well studied so that doctors can advise a good preventive treatment plan. However, there may be dozens of other mutations for which we don't know if they cause an illness (or not!), or there's no treatment available. 
 
Therefore, if you have family members with breast cancer- do speak with them to know more, and whether or not they had the genetics test. If yes, and they have the BRCA mutation, then it is good to consider a genetics test on yourself- if you have the BRCA mutation, your doctor will then speak with you for the necessary preventive surgeries: for breast cancer, and for ovarian cancer. All surgeries carry risks: of anaesthesia, bleeding, wound infections- so any decision should be made with good understanding of the pros/cons.  
 
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