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Prophylactic mastectomy, surgical removal of one or both breasts
before cancer appears, is a tough decision for women. Some
of the indications for prophylactic mastectomy are:
1) presence of mutation in one of the two breast cancer susceptibility
genes, BRCA1 and BRCA2.
2) women with a personal or strong family history of breast
cancer
3) presence of lobular carcinoma in-situ.
Retrospective reviews have shown that bilateral prophylactic
mastectomy significantly reduced breast cancer risk by 80-90%
in asymptomatic women. Since it is not possible to remove
all breast tissue, malignancy can still develop in the remaining
tissue.
Most women have an exaggerated perception of their breast
cancer risk. Accurate risk assessment is crucial before opting
for prophylactic surgery. Women who carry either BRCA1 or
BRCA2 mutation have the highest risk. The estimated lifetime
risk of breast cancer among mutation carriers is 56-85%, compared
to 5-8% in the general population. These women also tend to
develop cancer earlier, hence prophylactic mastectomy is likely
to benefit them most.
Due
to the physical and psychological effects of mastectomy on
women, and the fact that the procedure is irreversible, surgery
is proposed only after proper cancer-risk assessment, counselling
and considering other options. These include chemoprevention
and close surveillance(regular mammograms, clinical breast
examination and monthly self-examination).
Dr Ho Gay Hui
Consultant
Surgical Oncology
Dr Karen Yap
Associate Consultant
Surgical Oncology
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