Some women at high risk who have not been diagnosed with breast cancer consider prophylactic (preventive) surgeries. This includes mastectomy (removal of the breasts) and can sometimes include a complete hysterectomy (removal of the uterus and ovaries). While many studies have confirmed there is less breast and ovarian cancer among women who have had these organs removed, subsequent studies have questioned the use of such radical preventive measures because of quality-of-life issues and long-term side effects.
Since the introduction of prophylactic surgery, the medical community has failed to focus on issues of surgical complications and communicating risk-to-benefit information. A database search of studies on prophylactic mastectomy for the prevention of breast cancer uncovered research bias, poorly designed studies, and inappropriately prequalified participants. Researchers who evaluated 23 studies involving more than 4,000 patients concluded in a report featured in the Cochrane Database System Review that more rigorous prospective studies are needed, because “the state of the science is far from exact in predicting who will get or who will die from breast cancer. By one estimate, most of the women deemed high risk by family history (but not necessarily BRCA1 or 2 mutation carriers) who underwent these procedures would not have died from breast cancer.” The researchers reported that body image and feelings of femininity were adversely affected.
While many genetic counseling centers and research facilities continue to encourage these surgeries, women are advised to evaluate this decision carefully. Genetic testing is not designed to be a diagnostic tool. While research has confirmed that mutations of the BRCA1 and BRCA2 genes cause a predisposition to breast and ovarian cancer, many other genes have been identified that also can increase a woman’s risk. Until more research is done, genetic testing should not be the sole tool used to recommend serious surgeries.
High-risk women with a family history of breast tumor or who have tested positive for mutation of the BRCA1 or BRCA2 gene are advised to undertake an aggressive integrative prevention plan. In addition, those who are not taking tamoxifen can derive additional protection from indole-3-carbinol (abundant in cruciferous vegetables) or supplemental diindolylmethane (DIM). Aggressive screening is also recommended for these women. This may include the combination of mammogram with ultrasound and, for those with risk for ovarian cancer, an annual pelvic ultrasound. If your risk level is high, ask your doctor how you can step up your screening program.