Women's Health

Risk-Reduction Mastectomy for those with Ovarian Cancer

Risk-Reduction Mastectomy for those with Ovarian Cancer: Is it worth it?

A risk-reducing mastectomy is a type of surgical procedure that involves the removal of a woman’s breasts when there is an increased risk of developing breast cancer, yet there is no sign of breast cancer. Any woman who has had breast cancer is considered at high-risk of developing breast cancer again. However, undergoing a risk-reducing mastectomy is a serious decision that requires proper consideration.

More about the research study

Recent research has been conducted to determine the link between BRCA gene mutations and an increased risk of developing both breast and ovarian cancers. Charlotte Gamble, M.D., lead author and resident physician at Duke University School of Medicine, along with her team, conducted a study on BRCA mutation carriers in women with prior ovarian cancer. The study was published in the journal Annals of Surgical Oncology on July 11th. Gamble and her team constructed a two-face model that compared risk-reducing mastectomy to breast cancer screening (MRI and mammogram). The model took into account factors such as age of diagnosis, the period between diagnosis of ovarian cancer and risk-reducing mastectomy, treatment costs, BRCA mutation carriers, as well as cancer survival rates. Risk-reducing mastectomy was compared to breast cancer screening done every 6 months following diagnosis of ovarian cancer.

The researchers found the advantages of risk-reducing mastectomy greatly depended on the woman’s age at the time of her diagnosis and the time when the mastectomy was performed.

  • For women diagnosed at the ages of 40-50 with BRCA1 and BRCA2 gene mutations and at least five years after diagnosis of ovarian cancer, the procedure was associated with a survival advantage of 2-5 months compared to breast cancer screening. Moreover, the procedure proved to be cost-effective.
  • For women diagnosed at the ages of 60 and older, regardless of the time since diagnosis of ovarian cancer, survival months were minor and the procedure was found not to be cost-effective.
  • For women diagnosed at any age with BRCA1 and BRCA2 gene mutations within the first 4 years after diagnosis of ovarian cancer, prophylactic mastectomy was associated with a minor survival advantage and it too, was found not to be cost-effective.

Gamble and her team concluded that within the first five years, no patient seemed to benefit from the procedure. The survival advantage was seen only among the youngest and healthiest patients with ovarian cancer, that is, after the five-year diagnosis. Rachel Greenup, M.D., assistant professor of Surgery at Duke and senior author of the study also added that there is no right or wrong way in management the risk of breast cancer. Moreover, further research needs to be conducted in order to better understand the advantage to undergoing risk-reducing mastectomy following treatment of ovarian cancer.

Another example of a clinical study consisted of 509 women with ovarian cancer and carrying BRCA gene mutations. The study strived to determine whether or not ovarian cancer with BRCA gene mutation carriers could be prevented by preventative mastectomy or MRI screening. Proportional models were used to evaluate the impacts of both mastectomy and MRI screening on the occurrence of breast cancer. The results revealed 20 out of 509 patients developed breast cancer within 10 years following diagnosis of ovarian cancer. Among all patients with BRCA gene mutation carriers diagnosed with stage III/IV ovarian cancer at the ages of 50, the chances of dying before the age of 80 were reduced by less than 1% with MRI and less than 2% with mastectomy. Furthermore, greater benefits were seen in women who had already been cancer-free for 10 years following stage I or II ovarian cancer.

Researchers arrived to a conclusion that preventative mastectomy or MRI screening was only favorable in patients who had survived ovarian cancer without recurrence for 10 years and those with early stage ovarian cancer.

A third example of a clinical study was conducted on 639 women between the years 1960 and 1993.Each woman had a family history of breast cancer and had undergone risk-reducing mastectomy. 214 of these women were classified as being at high risk and 425 were classified as being at moderate risk of breast cancer due to their family history. Following risk-reducing mastectomy, 3 high risk women and 4 moderate risk women developed breast cancer between 2 and 25 years following their surgical procedures.

If you have had ovarian cancer and you are at high risk of developing breast cancer, your focus should be on either on risk reduction surgery, chemoprevention, or screening for early detection. There are a number of promising options available for early detection, such as magnetic resonance imaging (MRI) or digital mammography; however, such options are fairly limited. What’s more, each woman’s case is individual and your own requires an individualized approach. If you have a predisposition to BRCA, surgically removing both of your breasts can reduce your risk of developing breast cancer by 90%. There are three common types of risk-reducing mastectomy and it is important that you choose the right procedure for you. They include the following:

  • Nipple-sparing mastectomy – a surgical procedure that involves removing the entire breast tissue, including the ducts going up to the nipple and areola. However, it is possible to preserve a small amount of breast tissue with the nipple intact
  • Skin-sparing mastectomy – a surgical procedure that involves removing the nipple and areola. A large amount of the skin that surrounds the breast is not removed
  • Total mastectomy – a surgical procedure that involves removing the entire breast tissue, including the nipple, areola, and some of the surrounding skin

Speaking with your doctor may help you to assess your personal risk in undergoing any of the above procedures. However, the choice is yours to make. If you are pondering over whether to undergo surgery, there are several factors that you should take into consideration:

  • Your age
  • A personal history of breast cancer
  • A family history of breast cancer
  • Whether you plan on breastfeeding

What works best for you also depends on other factors, such as your body type and recovery options. Some helpful questions that you should consider asking your doctor are the following:

  • Which surgical procedure would you recommend for me? Why this procedure?
  • What are the different types of surgical procedures available to me and how are they performed?
  • Can I see any before and after images of risk-reducing mastectomy?
  • How much cancer risk is left after undergoing risk-reducing mastectomy?
  • What will the scars look like?
  • What are the overall costs to having risk-reducing mastectomy done?
  • Will I still need to undergo breast screening?
  • What are the common side effects of risk-reducing mastectomy?
  • Will breast screening interfere with risk-reducing mastectomy?
  • If I end up developing breast cancer, will the scar tissue make it difficult to detect the cancer?
  • What long does recovery last? Is it painful?

Now, more than ever, it is important to understand the meaning of carrying BRCA gene mutations and their association to breast and ovarian cancers. Keep in mind that having a BRCA mutation does not necessarily mean that you have to have a risk-reducing mastectomy. Explore your options - the decision is yours to make and at your own pace.