Hitting Cancer Before It Hits You:
When Is Preemptive Breast Cancer Surgery the Right Choice?

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Mark L. Sundermeyer, MD
Oncologist at Abington Health

Last May, Angelina Jolie started a national discussion about breast cancer treatment when she revealed that she had undergone a preventive double mastectomy and reconstruction. The then-37-year-old actress made the decision after discovering that she carries a mutation of the BRCA1 gene, which put her at high risk for developing breast or ovarian cancer (her mother died of the latter). More women are following suit and opting to have one or both healthy breasts removed in order to reduce their risk, but doctors say there are many factors to consider before making this life-changing decision.


You can learn more during Abington Health’s live web chat with Dr. Mark L. Sundermeyer tomorrow at 12 pm: The Latest Advancements in Breast Cancer Treatment.

Women like Jolie, who have a strong family history of breast and/or ovarian cancer, can have a simple blood test to determine whether they carry the genetic mutation that predisposes them to the disease. If they do, they may choose to have what is called a bilateral prophylactic mastectomy, where both breasts are removed. In other cases, breast cancer patients or survivors may opt to have a remaining breast removed (called contralateral prophylactic mastectomy) due to the high likelihood of developing the disease again.

Although the National Cancer Institute says that such surgeries are highly successful at reducing future breast cancer risk, most experts advise against preemptive or prophylactic surgery except in the very highest risk cases. That includes:

-       Women who inherit a genetic mutation (BRCA1, BRCA2, or others) that may greatly elevate their risk

-       Women with a strong family history of the disease. This means more than one immediate family member with breast or ovarian cancer, or a mother, sister, and/or daughter who was diagnosed with breast cancer before age 50.

-       Women with lobular carcinoma in situ (LCIS), a condition in which abnormal cells are found in the lobules of the breast, in addition to a strong family history of breast cancer

-       Women who have undergone radiation therapy to the chest region before the age of 30 

Health care providers often have access to advanced assessment tools to help determine your individual risk and the approach that is best for you. If you don’t meet the criteria for “very high risk,” there are other, non-surgical options to consider, including certain medications and more frequent screenings. Ultimately, no one choice is right for everyone so speak with your medical care provider.

Learn more about breast cancer at tomorrow's Health Chat with Abington Health at 12 pm:  The Latest Advancements in Breast Cancer TreatmentSign up here.


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