Is surgery to reduce the risk of breast cancer right for you?

Published: Oct. 11, 2016 at 4:14 PM CDT|Updated: Oct. 12, 2016 at 12:28 PM CDT
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CAPE GIRARDEAU, MO (KFVS) - Some women are at higher risk of developing breast cancer than others because of their genetic makeup.

That is the case for people like Angelina Jolie, who came out in 2013 saying she was getting a preventative double mastectomy because doctors told her she had an 87 percent risk of breast cancer.

If you carry the disease-causing mutation in the BRCA1 or BRCA2 gene, the risk of contralateral breast cancer is about 10 to 25 percent, according to Dr. Olivia Aranha, an oncologist at Saint Francis Medical Center.

However, Dr. Aranha says some studies have estimated the risk to be as high as 65 percent for BRCA1 carriers and 50 percent for BRCA2 carriers.

In some cases, patients might also have a greater chance if they have the CHEK2 mutation.

The good news: there are options to reduce the risk.

What are the options?

If you have a strong family history of breast cancer or test positive for a gene mutation that increases your risk of breast cancer, there are several options.

Dr. Aranha says it is recommended BRCA carriers be offered the opportunity to have a prophylactic bilateral mastectomy.

This is a surgery to remove one or both breasts to reduce a woman's risk.

The other option would be to have an annual screening mammogram and an annual breast MRI.

Can a prophylactic mastectomy fully protect women from breast cancer?

The National Cancer Institute reports a prophylactic mastectomy is the most common risk-reducing surgery.

It can reduce the risk of developing breast cancer by 95 percent. In women with a strong family history of breast cancer, the procedure can reduce the risk of breast cancer development by up to 90 percent.

However, Dr. Aranha does point out that there is no clear overall survival benefit for most breast cancer patients who undergo the procedure. Aranha says no randomized trials have been performed.

Furthermore, a mastectomy does not affect your risk of cancer recurring elsewhere like in the bone, liver, lung or brain.

The National Cancer Institute also reports that even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed.

Are there any health concerns related to the procedure?

Dr. Aranha says the mortality rates are uniformly low, less than 1 percent, in patients that undergo an elective mastectomy.

Some complications include: seroma, surgical site infection (SSI), skin flap necrosis, nipple necrosis, postoperative pain, postmastectomy pain syndrome, phantom breast syndrome, arm mobility limitations, pneumothorax, brachial plexopathy, and the risks of an anesthetic and reconstruction, if performed.

The elective mastectomy is permanent and irreversible, meaning women will no longer have the ability to breastfeed from the affected breast(s).

What's next?

Dr. Aranha says the decision about whether to undergo surgery is based on personal preference, given that effective screening is available.

If you're at a high risk of developing cancer, it's important to discuss all your options for risk reduction with doctors and loved ones.

To get in touch with a doctor at Saint Francis, click here.

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