Preventive Surgery to Reduce Breast Cancer Risk

Should I consider surgery to lower my risk of breast cancer?

For some women who have a very high risk of breast cancer, preventive surgery to remove the breasts (prophylactic mastectomy) or surgery to remove the ovaries (prophylactic oophorectomy) may be options to lower their risk.

You might consider preventive surgery if you:

  • Have a mutation in the BRCA1 or BRCA2 gene (or certain other genes that increase breast cancer risk) that is found by genetic testing
  • Have a strong family history of breast cancer (such as breast cancer in several close relatives, or breast cancer in at least one relative at a young age)
  • Have a history of lobular carcinoma in situ (LCIS)
  • Had radiation therapy to the chest before age 30
  • Have (or have had) cancer in one breast (especially if you also have a strong family history)

Like any type of surgery, these operations have risks and side effects, some of which could affect your quality of life. Because of this, preventive surgery is not usually a good option for women who are at average risk of breast cancer, or for those who are at only slightly increased risk.

Prophylactic mastectomy

A prophylactic mastectomy is surgery to remove one or both breasts to lower the chances of getting breast cancer. While a prophylactic mastectomy can lower this risk by 90% or more, it doesn’t guarantee that you will not get breast cancer. This is because it's not possible to remove all breast cells, even with a mastectomy. The breast cells that are left behind might still go on to become cancer.

There are two main situations in which a prophylactic mastectomy might be considered.

For women at very high risk of breast cancer

For women in this group, removing both breasts (known as a bilateral prophylactic mastectomy) before cancer is diagnosed can greatly reduce (but not eliminate) the risk of getting breast cancer. 

Unfortunately there’s no way to know for sure ahead of time if this surgery will benefit any particular woman. For example, most women with a BRCA1 or BRCA2 gene mutation will develop breast cancer at some point. Having a prophylactic mastectomy before the cancer occurs might add many years to their lives. But not all women with BRCA1 or BRCA2 mutations develop breast cancer. For some women the surgery might not have been helpful. Although they might still get some important benefits from the surgery such as peace of mind, they would also have to deal with its aftereffects.

For women already diagnosed with breast cancer

Some women who have already been diagnosed with breast cancer choose to have the other breast removed (known as a contralateral prophylactic mastectomy, or CPM) at the same time to help lower their risk of developing a second breast cancer. 

This is more likely to be a good option for women who have other factors that increase their risk of getting another breast cancer, such as a BRCA1 or BRCA2 mutation or a strong family history of breast cancer.

But for women without a family history of breast cancer or other risk factors, the benefit of a CPM is less clear. Having breast cancer does raise your risk of getting cancer in the other breast, but this risk is still usually low, and many women overestimate this risk. And while CPM lowers the risk of getting cancer in the other breast, for most women it does not increase the chances of living longer.  

It’s very important to talk with your health care provider so that you understand how much this type of surgery is likely to benefit you, versus the likelihood of risks and side effects. You might also want to get a second medical opinion, as well as talk to other women who have had this surgery, before deciding if it’s right for you.

Prophylactic oophorectomy (removal of the ovaries)

The ovaries are the body’s main sources of estrogen, a hormone that can help some breast cancers grow. Women with a BRCA1 or BRCA2 mutation can reduce their risk of breast cancer by about half by having a prophylactic oophorectomy, which removes the ovaries (and usually the attached fallopian tubes as well). Some women have this surgery done along with a prophylactic mastectomy.

Women with a BRCA1 or BRCA2 mutation also have a high risk of developing ovarian cancer. Most doctors recommend that women with one of these mutations have their ovaries surgically removed once they finish having children to lower this risk.

Removing the ovaries causes a woman to go into menopause. This can lead to symptoms such as hot flashes, trouble sleeping, vaginal dryness, loss of bone density, and anxiety or depression. 

Again, it’s important to talk to your health care provider so that you’re well informed about the possible benefits, risks, and side effects of this type of surgery. You might also want to talk to other women who have had this surgery before deciding if it’s right for you.

Other options to reduce breast cancer risk

If you’re concerned about your breast cancer risk, talk to your health care provider. They can help you estimate your risk based on your age, family history, and other factors. If you are at increased risk, you might consider taking medicines that can help lower your risk. Your health care provider might also suggest you have more intensive screening for breast cancer, which might include starting screening at an earlier age or having other tests in addition to mammography.

There are also other things that all women can do to help lower their risk of breast cancer, such as being active, staying at a healthy weight, and limit or avoiding alcohol. For more information, see Can I Lower My Risk of Breast Cancer?

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Wong SM, Freedman RA, Sagara Y, et al. Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer. Ann Surg. 2017;265(3):581-589. 

 

Last Medical Review: September 6, 2017 Last Revised: September 6, 2017

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