Since people with a BRCA1 and BRCA2 pathogenic variant are at high risk of developing breast and ovarian cancer. Risk-reducing surgeries significantly decrease the likelihood of developing cancer. Risk-reducing surgeries are considered the most effective current method for cancer prevention.
Surgery for Breast Cancer Risk Reduction
What is a risk reducing mastectomy?
A mastectomy involves the surgical removal of one or both breasts, commonly used in treating or preventing breast cancer. "Prophylactic mastectomy" or "risk-reducing mastectomy" specifically refers to removing breast tissue to decrease the likelihood of developing breast cancer. Risk-reducing mastectomy with or without reconstruction is a preventive option that reduces breast cancer risk by over 90%.
What are the BRCA1 and BRCA2 guidelines for a mastectomy?
The NCCN Guidelines and UCSF Center for BRCA Research Steering Committee provide expert recommendations for people with a pathogenic variant to manage their cancer risk. The official guideline is that risk-reducing mastectomy with or without reconstruction is a preventative option that reduces breast cancer by over 90% that should be discussed with your healthcare team. Given the early detection possible with MRI, and higher survival rate, there are no guidelines for if and when.
Do risk reducing mastectomies eliminate the chances of getting cancer?
This surgery greatly reduces the chance of developing breast cancer. The exact risk after surgery depends on the surgical procedure but is usually under 5%. Small amounts of breast tissue may still remain post surgery, meaning the risk for breast cancer is not completely eliminated. However, the reduction in risk is substantial, making the risk of getting cancer much smaller than the average person’s risk of breast cancer.
What is breast reconstruction? What are the different types of breast reconstruction?
Breast reconstruction is a surgical procedure aimed at rebuilding a breast’s shape, appearance, and symmetry following a mastectomy. The type of reconstruction that can be performed depends upon a person's body type, the amount of tissue they have available to be used in reconstruction, age, and overall health. Choosing a breast reconstruction method is very personal, and it is important to communicate your goals to your health care team to get the procedure that is best for you. Three common methods for breast reconstruction include no breast reconstruction, implant reconstruction, and autologous reconstruction.
No breast reconstruction:
When a woman opts not to undergo breast reconstruction after a mastectomy and chooses to have a flat chest instead, it is often referred to as "going flat." Some individuals may have surgeons use a small part of tissue to smooth out the chest area to avoid indents.
Implant Reconstruction:
The surgeon places an implant inside the breast, which may be filled with either silicone gel or saline. Most often, the surgeon first uses a tissue expander that is filled over several weeks to create space for the implant, before placing the implant.
Autologous Reconstruction:
This method is also called free tissue transfer or free flap. The surgeon takes tissue, such as skin, fat, blood vessels, and sometimes muscle, from another area of the body to rebuild the breast.
What are some recommended resources to learn more?
UCSF BRCA Workshop: Risk-Reducing Surgeries for Breast and Ovarian Cancer: Options and Timing
Surgery for Ovarian Cancer Risk Reduction
What is a risk-reducing salpingo-oophorectomy?
A salpingo-oophorectomy is a surgical procedure that involves the removal of one or both fallopian tubes and ovaries. "Prophylactic salpingo-oophorectomy" or "risk-reducing salpingo-oophorectomy" specifically refers to removing both fallopian tubes and ovaries to decrease the likelihood of developing ovarian cancer, particularly in people with a high genetic risk due to inherited pathogenic variants. Risk-reducing salpingo-oophorectomy is a preventative option that reduces ovarian cancer risks by over 90%.
What are the BRCA1 and BRCA2 guidelines for salpingo-oophorectomy?
The NCCN Guidelines and UCSF Center for BRCA Research Steering Committee provide expert recommendations for people with a BRCA pathogenic variant to manage their cancer risk. Risk-reducing salpingo-oophorectomy is recommended between age 35-40 for BRCA1, and 40-45 for BRCA2, when child bearing or fertility preservation is complete or not desired. Risk-reducing salpingo-oophorectomy reduces ovarian cancer risks by over 90%. Surgeons performing this surgery should follow the high-risk protocol for surgery and pathology.
Do risk-reducing salpingo-oophorectomy eliminate the chances of getting cancer?
What we call “ovarian” cancer includes cancer that starts in the ovaries, fallopian tubes, or peritoneum (a tissue that lines the inside of the abdomen). Risk-reducing salpingo-oophorectomies eliminate the chances of getting ovarian or fallopian tube cancer. There is still a small risk of primary peritoneal cancer, which is estimated to be 1-3%, similar to the average person’s risk of ovarian and related cancers.
What is hormone replacement and why is it important?
The ovaries are the body’s main source of the hormones estrogen and progesterone. Having a salpingo-oophorectomies before natural menopause will cause menopause. This can result in various physical side-effects, such as hot flashes, vaginal dryness, mood changes, night sweats, and loss of bone density, though every person's experience is different. For many people with BRCA1 and BRCA2, hormone replacement therapy is a safe option and involves the administration of hormones to help alleviate symptoms of menopause.