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The difficult decision of having a preventative mastectomy

Dana-Farber Cancer Institute

Last month, when actress Angelina Jolie announced that she decided to undergo surgery to have her breasts removed to reduce her chances of developing breast cancer, public attention has been focused on prophylactic mastectomies, a procedure which has increased in popularity in recent years.

Click 'Read More' to hear our interview about prophylactic mastectomies.

This week on “Take Care,” an interview with Dr. Ann Partridge, founder and director of the program for Young Women with Breast Cancer and director of the Adult Survivorship Program at the Dana Farber Cancer Institute.

There has been a drastic increase in prophylactic mastectomies, Dr. Partridge said, which is generally chosen as an option by two groups of women. Breast cancer survivors opt for the procedure mainly because they are genetically predisposed to getting breast cancer. Young survivors often elect to undergo surgery especially since the risk increases with age.

Women, like Jolie, who have never been diagnosed with breast cancer, but are genetically predisposed or have a strong family history of breast cancer, are among those who are increasingly choosing to endure surgery in order to reduce those risks in the future. Dr. Partridge says that family history can have a profound influence on the choice a woman makes.

“Those women do it to obviously reduce their risks, although there are alternatives. Having bilateral mastectomies, taking both breasts off, is fairly drastic so a woman really needs to think this through and decide if it’s the right thing for her, especially in the absence of ever being diagnosed with a cancer,” she said.

Dr. Partridge says that women often come to consultations with strong attitudes on what they want to do, but the doctor’s attitude can still play a role. She said that she helps figure out what is best for each individual patient by practicing evidence based medicine, relying on results from the procedures, and value based medicine, outlining the choices and deciding which path a woman should take.

An aggressive awareness campaign that promotes women to practice monthly breast exams and receive mammograms may have contributed to a bit of anxiety surrounding the issues, Dr. Partridge says. But she says that the better information a woman can get, combined with good counseling and support, can lead a woman to the right decision for her on whether or not to undergo the surgery.

“The more information we have, the better we can manage our risks,” she says.

Dr. Partridge points out that taking off a healthy breast has – to date -- not been shown to impact survival, although it can still help women if they were diagnosed with breast cancer early. She says that doctors reserve the suggestion mainly for women who are at a very high risk, including women who are mutation carriers or have other predispositions.

Women do not appear to regret their decisions to undergo surgery or not, Dr. Partridge said, since women often are very invested in the decisions they’ve already made. Those who do opt for mastectomies can suffer from some mild pain, body image and sexuality issues, but Dr. Partridge says that overall, they still have a good quality of life.

“We find that the women who’ve undergone mastectomies clearly have more issues on average, however their quality of life in general tends to be fairly good and not just diminished.”