Clinical

Prophylactic mastectomy may prevent more cancer deaths than screening

SAN FRANCISCO, Jul 09 (Reuters) - The "zenith of prophylactic mastectomy" is approaching, predicted researchers meeting at the American Cancer Society Second National Conference on Cancer Genetics here.

According to Dr. Kevin S. Hughes, co-founder of The Lahey Clinic Breast Cancer Center in Peabody, Massachusetts, prophylactic mastectomy was offered to the wrong women in the past. "We now can identify a high risk patient--not like 20 or 30 years ago, when we removed lumpy breasts," he noted.

In a presentation on prophylactic mastectomy, Dr. Hughes and colleagues discussed past problems, current considerations and future possibilities associated with the procedure.

In the past, clinicians often relied on a combination of factors to determine a patient's risk, with varying degrees of success. With rudimentary reconstruction procedures, limited treatment options and no chemoprevention, Dr. Hughes and colleagues contend that the prophylactic procedure "lost credibility".

At present, identification of BRCA1 and BRCA2 mutation carriers and the patient's own history allow for a better definition of those patients at highest-risk for whom prophylactic mastectomy must be a consideration. Also, while cures are not yet 100%, adequate therapeutic strategies exist along with reconstruction options.

"Prophylactic surgery will greatly increase the number of women who never develop breast cancer," Dr. Hughes said. "If there is ever a time when this procedure makes sense, we are reaching that time."

Dr. Hughes and colleagues note that, "...at least for now, prophylactic mastectomies may prevent more cancer deaths than screening." In the future, the investigators expect an even more refined definition of the high-risk patient based on genetic screening, and other factors still to be elucidated.

"When advanced screening technology is available, or when all breast cancer can be cured regardless of stage or when all breast cancer is prevented prophylactic mastectomy will become obsolete," the researchers write in an accompanying handout.

-Westport Newsroom 203 319 2700 -Story by Sandra Katzman