For some women, preventive mastectomies pay off

A long-term study of women with a genetic predisposition for breast or ovarian cancer showed that those who elected major preventive surgeries had a significantly reduced risk of those cancers.

The study, published Sept. 1 in the Journal of the American Medical Association, confirms the view of one of its researchers, Gail Tomlinson, M.D., Ph.D., interim director of the Greehey Children's Cancer Research Institute at The University of Texas Health Science Center at San Antonio.

Dr. Tomlinson said that for women with certain genetic mutations, risk-reducing mastectomies and removal of the fallopian tubes and ovaries can be worth it for the women and their families.

"We have believed this for 15 years," said Dr. Tomlinson, "but it's been so controversial — removing organs for cancer risk."

The idea can be jarring unless one considers that the women with the specific genetic mutations, BRCA1 and BRCA2, are seeing people in their family suffering from these cancers one after another, Dr. Tomlinson said. She noted that often these are women with young families and careers to worry about, and the worry about dying from cancer at an early age because of familial predisposition can be overwhelming.

"This is a compromise women are willing to accept and their husbands are willing to accept, because the whole family worries about whether the women are going to get breast cancer," Dr. Tomlinson said.

The study does not address quality of life issues after such radical surgery, and Dr. Tomlinson said that is a concern that must be weighed by the women and their families. But the relief of having that risk taken away is hard to measure.

The study also supports Dr. Tomlinson's effort to build a genetic program at the Cancer Therapy & Research Center at the UT Health Science Center, she said, noting that the first steps have been taken with the hiring of a genetic counselor to work with families at risk for cancer. It's a program that will have benefits across the generations, she said, helping people identify and deal with hereditary risks associated with more than just those two cancers.

In addition to breast and ovarian cancer, she said, "certain types of thyroid and kidney cancer run in families and early intervention can be lifesaving."

The study followed nearly 2,500 women at higher risk for breast or ovarian cancer because of two genetic mutations between 1974 and 2008 at 22 centers in Europe and North America.

In 247 women who chose risk-reducing mastectomies, no breast cancers were diagnosed, while one in 13 of the 1,372 who did not have the surgery were diagnosed with breast cancer. Women who had their ovaries and fallopian tubes removed had a lower risk of ovarian cancer, including those with prior breast cancer, and a lower risk of dying from either cancer.

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