Who might consider Risk Reduction (Prophylactic) Surgery for Breast Cancer?
Risk Reduction Surgery is one of a range of options available to women who are at high risk of a future breast cancer diagnosis and involves removal of nearly all the breast tissue and is usually performed with an immediate bilateral breast reconstruction. Only 10% of breast cancer cases are thought to have genetic link although below the age of 40 a genetically inherited predisposition for breast cancer is more likely. These issues can be even more complex where a woman wishes to consider risk reduction surgery after a diagnosis of breast cancer. Risk reduction surgery is a major undertaking that requires a great deal of commitment from the patient and their immediate family. A wide range of important assessments are needed to ensure that this is the correct treatment in each individual case.
The first step for anyone who is concerned that they may be at increased risk is a detailed examination of their family history (of first and second degree relatives on both the maternal and paternal sides of the family). This should include age at diagnosis, multiple cancers and sites of cancers (particularly breast and ovarian cancers). Depending on the results of this you may be referred for genetic counselling and genetic testing to more precisely estimate your own risk of breast cancer in line with current NICE guidelines. Genetic counselling and testing is provided by specialist regional genetics teams.
What are the risks of developing breast cancer?
- Normal population risk for developing breast cancer is approximately 12-13% over the lifetime of a woman living in the UK.
- A woman estimated to have a lifetime risk of less than 17% is regarded as being of normal population or near population risk and would normally be invited to participate in the NHS Breast screening programme as standard (commencing age 47-50) with 3 yearly mammograms.
- Women with a lifetime risk of 17-30% are considered to be in a moderate risk group and can usually be managed in secondary care with increased screening (usually from age 40) and other strategies, including discussion of reducing risk with drugs such as prophylactic Tamoxifen.
- Women at high risk of breast cancer have a greater than 30% lifetime risk of developing breast cancer after specialist genetic risk assessment. This includes women who have been found to have BRCA gene mutations (BRCA 1 or BRCA 2) who may have a risk of developing breast cancer of greater than 80% during their lives.
It is for these high risk patients that risk reduction surgery may offer a good strategy to manage their future breast cancer risk. Alternatives to surgery for women at high risk include increased screening, including Magnetic Resonance Imaging (MRI) screening and chemoprevention (using drugs to reduce breast cancer risk).
The decision to proceed with risk reduction surgery is an intensely personal choice which requires a great deal of personal strength and courage. Mr Hawkins will help to explain what options may be appropriate for you and can help you to make fully informed decisions . For woman considering risk reduction surgery it is important that all of your options are explained and that you have been through a full psychological counselling process to prepare for the upcoming surgery.
Risk reduction surgery is now established as an excellent option for reducing breast cancer risk when performed in the correct setting and can empower patients to take back control of their lives. Whilst no risk reduction surgery can ever completely remove the risk it has the potential to reduce the chance of developing breast cancer to levels well below those seen in the general population (<10%). A wide support network composed of surgeons, breast care nurse specialists, geneticists, radiologists, psychologists and GP support will be essential and available to you if you decide to proceed.