Prophylactic mastectomy at 21?
Doctor Answers 6
I am sorry to hear about your mom and happy that you are looking to take a proactive approach to your own health. The fact that your mom had premenopausal breast cancer does put you at increased risk for developing it yourself, but not necessarily enough risk to warrant removing your breasts. We have genetic testing now that can identify whether or not you have a gene we have identified as placing you at increased risk for breast cancer. I recommend you speak to a genetic counselor regarding this test. Your mother should also undergo testing, if possible. If she is negative for any of the genes responsible for breast cancer that we know of, then you are negative also. If your mom or you are found not to carry any of the known genes that predispose to the development of breast cancer, you may still be a candidate for prophylactic mastectomy since we do not yet have all the genetic answers to breast cancer. There are ways to assess your accurate risk even without a genetic abnormality.The majority of breast cancers are sporadic mutations that develop in an individual and not related to any known genes. If a genetic counselor determines you have a gene dramatically increasing your risk for breast cancer (such as BRCA), OR if you are negative for any known gene but still are considered at higher risk, you may consider prophylactic mastectomy. Another option in the case of non BRCA gene mutation is close followup by a breast expert for breast exams, and imaging studies (mammogram, ultrasound and MRI). Prophylactic mastectomy may be life saving but is not without consequences and should not be done without a lot of thought and consultation with experts- genetic, surgical and plastics. Good luck to you and take care.
Breast Oncology Surgeon's Recommendations for Prophylactic Mastectomies
As a breast surgeon that routinely performs mastectomies (both for cancer and for prophylaxis), I see many patients with these same questions. There are some initial steps to take - the first is to see if we can pin down a genetic mutation. Many people are familiar with BRCA genes, but there are others as well. If any of your relatives with cancer have been or could be tested themselves, if they are positive for a mutated gene, we would then recommend you to be tested to see if you share this gene. Fewer than 5-10% of all cancers are actually associated with a mutation, but if you have other cancers in your family, there are different panels that we order depending on the pattern of cancer in your family. If we found a mutation in your mother (or other relative) that explains why she developed her cancer, you would have a 50% chance of having it too. That also means you have a 50% chance of NOT having it - which would be a as if your were adopted (from a cancer standpoint only, of course). You could still get cancer, but with an average risk and additional worry wouldn't be necessary. Some families have a very concerning pattern for cancers and we don't detect mutated genes in affected family members. This means that they either
A) Have a combination of genes and no one test can predict risk,
B) Have a mutated gene that we haven't discovered yet and can't detect, or
C) Are just normal and really unlucky.
For these families, we assume healthy relatives have increased risk and tailor surgery and screening recommendations to the situation. For some women, that does mean prophylactic mastectomies even without documented BRCA mutation status (or other risk-elevating mutation). We do not usually recommend testing healthy people with family history of cancer unless we have no way of testing those who have actually already had the cancer themselves. If you are tested and positive - we can quote you statistics on risk and guide you through options. If you don't have a family member with cancer who can be tested, or they refuse, if you test negative, that won't help with decision making because we won't know if you just didn't get the bad gene (hooray!), or if there wasn't a bad gene in the first place and we don't know what to tell you (shucks.). With the information that you have supplied, I would not rush to seek information about surgery at this point. Talk with someone comfortable about breast health and cancer risk (your OB/GYN, a breast health surgeon, or a primary care MD), get a clearer idea of what your specific risk is, and see what the best next steps are to keep you happy and healthy for as long as possible.
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See a geneticist and breast surgeon with your mother and your history.
They can advise you better.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.