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Prophylactic Surgery: For Whom, When and How?

Christine Mau1, Michael Untch1

  • 1Interdisziplinäres Brustzentrum, Helios-Klinikum Berlin-Buch, Berlin, Germany.

Breast Care (Basel, Switzerland)
|February 20, 2018
PubMed
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The Importance of Continued Vigilance after Risk-Reducing Mastectomy in BRCA Carriers: A Case Report.

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Risk-reducing surgery, including mastectomy and salpingo-oophorectomy, significantly lowers cancer mortality in high-risk women, especially BRCA mutation carriers. Careful patient counseling on surgical options is essential for informed decision-making.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Genetics

Background:

  • Women with pathogenic BRCA1/2 mutations face significantly elevated risks for breast and ovarian cancers.
  • Risk-reducing surgery is a viable option for healthy women with identified high cancer risks.

Purpose of the Study:

  • To evaluate the impact of risk-reducing surgeries on cancer mortality in high-risk women.
  • To outline indications and benefits of prophylactic mastectomy and adnexectomy in BRCA mutation carriers.

Main Methods:

  • Review of surgical outcomes for risk-reducing bilateral mastectomy and contralateral mastectomy (CPM).
  • Assessment of risk-reducing salpingo-oophorectomy benefits in BRCA carriers.
  • Consideration of patient-specific factors like age and primary disease prognosis.
Keywords:
Hereditary breast and ovarian cancerRisk reductionSurgery

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Main Results:

  • Risk-reducing bilateral mastectomy demonstrably reduces breast cancer mortality, particularly in younger patients.
  • Contralateral mastectomy (CPM) has proven mortality reduction benefits for BRCA mutation-related cancers.
  • Risk-reducing salpingo-oophorectomy can prevent ovarian cancer in up to 95% of BRCA carriers, necessitating hormone replacement therapy in premenopausal women.

Conclusions:

  • Prophylactic mastectomy and adnexectomy are effective strategies for reducing cancer mortality in BRCA mutation carriers.
  • Individualized surgical decision-making, considering prognosis and patient counseling, is crucial.
  • Risk-reducing surgery offers significant survival benefits for women predisposed to hereditary breast and ovarian cancers.