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Preventative Mastectomies

Posted Sep 07 2008 8:10pm

Best of a bad lot from The Globe and Mail (scroll down)

Women born with two specific genetic mutations, BRCA1 and BRCA2, face a daunting future -- they have an 87-per-cent chance of developing breast cancer.

The best way of dealing with these mutations -- having both breasts surgically removed before the cancer has a chance to develop -- is almost equally grim.

Many of these women are extremely reluctant to undergo a disfiguring mastectomy even though it might be life-saving, notes Professor Kelly Metcalfe of the University of Toronto.

So Prof. Metcalfe and her researcher colleagues set out to find a more acceptable option, by examining survival statistics from different types of mastectomies.

In a total mastectomy, the entire breast is removed, which reduces the chance of cancer by almost 100 per cent.

The results of subcutaneous mastectomies are almost as good, with a 95-per-cent reduction in cancer risk. In this procedure, most of the breast tissue is removed but the skin, plus the nipple and surrounding areola, are preserved.

That means these woman have a more realistic appearance if they undergo breast reconstructive surgery using implants or tissue taken from the abdominal region.

"It's not a 100-per-cent guarantee, but it is the best thing that we know right now, except for a total mastectomy," said Prof. Metcalfe.

Prof. Metcalfe's study, published in the journal Lancet Oncology, shows that women would be more willing to undergo a subcutaneous mastectomy, compared with the more radical operation.

"The majority of these women are young -- they are 30 to 40 years old. So, they want to have a good cosmetic outcome."

But, she added, many surgeons would rather perform a total mastectomy in order to reduce the cancer risk as much as possible.

"Why would we refuse women this option when they are not willing to do anything else?" she asked. Their odds of getting breast cancer would still be lower than the average woman who faces a 9 per cent to 11 per cent lifetime risk. [my emphasis]

Women who have a total mastectomy can also undergo reconstructive breast surgery, minus their own nipples and areola.

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Are doctors really reluctant to perform subcutaneous mastectomy rather than total mastectomy because a subcutaneous mastectomy is slightly less effective at preventing breast cancer than a total mastectomy? Or is something else, such as difficulty of procedure, at play here?

See also Subcutaneous Mastectomy Viable Option: U of T Research

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