A study, published in Lancet Oncology, has demonstrated that prophylactic mastectomy reduces the breast cancer risk by 89.5 to 100 per cent, in women who carry the inherited BRCA1 and BRCA2 mutations.
These women have an 80 per cent risk of developing breast cancer during their lifetimes, says Kelly Metcalfe, at the University of Toronto, but surgery rates among affected women are very low.

Preservation of body image is a main concern in deciding for or against surgery, she notes, so subcutaneous mastectomy, which reduces cancer risk by about 95 per cent, should be considered as an option.

Unlike total mastectomies - which reduce cancer risk by almost 100 per cent -- subcutaneous mastectomies preserve nipple and areola tissue, which allow for a better cosmetic outcome. It is this residual breast tissue that leads to the assumption that it is an inferior mode of prophylaxis.

Metcalfe and her colleagues at University of Toronto and Sunnybrook and Women's College Health Sciences Centre examined published reports of breast cancers that developed after prophylactic bilateral mastectomies to assess whether subcutaneous mastectomies are indeed a viable preventive measure.

They found that only seven of 639 women who had undergone subcutaneous mastectomies in a Mayo Clinic study developed breast cancer, and only one of them had cancer in the nipple.
There were only four other documented cases of breast cancer following the procedure.

" The lifetime risk of breast cancer for a BRCA carrier following a subcutaneous mastectomy is about four per cent, or roughly half that of a non-carrier with two breasts intact," says Metcalfe. "Therefore, shouldn't we consider this as a viable prevention option for women with a BRCA mutation ?"

Source: University of Toronto, 2005


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