Preventive mastectomy

Every surgeon decides whether or not to do surgery. Even if a bunch of non-surgeons recommend surgery, it is the decision of the surgeon.



I think most surgeons will consider doing prophylactic mastectomies on women who have a BRCA mutation because their risk of breast cancer and ovarian cancer is so high.



If you make an appointment with a board-certified genetics counselor (usually found at major institutions) , they should be able to give you an estimate of your risk for a BRCA mutation. Only about 5-15% of breast cancers are from BRCA. If these relatives had PREMENOPAUSAL breast cancer, then they may be at higher risk for having a BRCA mutation. Remember, about 1 in 8 or 1 in 10 women will get breast cancer in their lifetime. Your family tree will help determine your risk. If you have small families and few women in your family tree, then your family history may be more significant.



Even if you find a surgeon who would do the surgery, you will have the problem of whether the insurance company will pay for it (unless you are self-pay.)



I think most surgeons would want to do a biopsy, whether fine needle, core or excisional biopsy (and find cancer or precancer), before they would consider doing a mastectomy for microcalcifications and dense breasts, unless they had some very good reason to think they were cancerous. Remember, 80% of biopsies are benign.

Bopsie,



I believe that you need to be tested BRCA1 positive to get the surgery. My mother and 2 ants died of breast cancer and I asked my doctor to get the prophylactic mastectomy. He said that I had to be tested positive to be referred to a surgeon. I did that a year and a half ago. I got the oopheroctomy a month ago and the mastectomy is coming in May. So I friendly suggest that you ask questions right now.

My statistics are 90% chance of breast cancer and 60% ovarian cancer.

I do not have the brca gene, but my geneticist told me he would write a strongly worded letter in favor of the mastectomy and 9 times out of 10, the insurance companies will listen to him even with brca negative if there is compelling family history plus psycological distress. I DID have psycological distress. As it turned out, I also had cancer, so the letter wasn't necessary.