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Should You have Preventive Cancer Surgery?

July 06, 2015

Preventative cancer surgery has gained traction in the presses over the past few years as celebrities such as Angelina Jolie and have opted for the preventative measures. Every day, many women face the same choices as they consider their options for proactive treatment of breast and gynecological cancers.

Many people who have had close relatives with cancer often worry about getting the disease themselves. Family history is one of the most significant risk factors for cancer. While preventive surgery doesn’t completely eliminate this risk, it significantly lowers it. If you have significant genetic risk factors for cancer, preventive surgery is an important option to consider.

What is preventive cancer surgery?

The average woman has a 12 percent risk of breast cancer. However, women with a mutation of the BRCA1 gene have a five times greater risk of developing the disease. A strong family history of breast cancer and a mutation in the BRCA2 gene or two other genes associated with breast cancer also significantly increase a woman’s risk.

In these cases, preventive cancer surgery likely will involve the removal of one or both breasts during a mastectomy. A bilateral prophylactic mastectomy is the most common type of preventive cancer surgery. This procedure involves either the removal of both breasts and the nipples or the removal of only breast tissue, which is called a subcutaneous or nipple-sparing mastectomy. The first option, a total mastectomy, greatly reduces breast cancer risk because it removes more breast tissue.

Another type of preventive cancer surgery involve s removal of the ovaries and fallopian tubes. Removal of the ovaries reduces the amount of estrogen the body produces, specifically in women who are about to begin menopause. This is very important because estrogen plays a significant role in the development of certain breast and ovarian cancers. Some research has shown that women in perimenopause who have undergone this process reduced their ovarian cancer risk by 85 to 95 percent and their breast cancer risk by at least 50 percent, according to the American Cancer Society.

Potential risks & post-surgery side effects

If you may be a candidate for preventive cancer surgery, it’s important to understand what happens after surgery.

Removing the ovaries causes early menopause. For women who want to conceive or have more children, this is an important consideration. If you choose to proceed with preventive surgery, we will probably suggest hormone therapy to replace the estrogen you’ve lost with progestin and estrogen. Women who have their ovaries surgically removed need both of these hormones because using estrogen alone may increase the risk of uterine cancer.

Preventive surgery is irreversible. The decision to have surgery is a very personal one that every woman should make in consultation with her doctor. For some women, medication may be a better option than surgery. One non-surgical option is chemoprevention, which involves using anti-cancer drugs to reduce cancer risk or slow its development. Birth control pills also reduce the risk of developing ovarian cancer. Women who use them for at least five years have a 50 percent lower risk compared to those who have never used oral contraceptives at all. However, birth control pills may increase breast cancer risk in some women, so talk to your doctor before you consider this option.

If you have a family history of breast or ovarian cancer talk to your doctor about whether preventive surgery is appropriate for you. Genetic counseling or testing can help to determine whether you have one or more gene mutations that increase your risk for certain cancers.

Once you have this information, work with your doctor to make the best decision for you personally. Preventive surgery is not the only way to reduce your risk for cancer, and these procedures are not right for everyone. Women who are at the highest risk for developing cancer should consider surgery because it often leads to more significant risk reduction than non-surgical approaches. But whatever path you take, this is an extremely personal decision and the choice ultimately is yours.

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