People with a personal history of cancer or strong family history of breast, ovarian, or related cancers may undergo genetic counseling and genetic testing. The procedures can determine if they have a mutation that causes a higher risk. BRCA gene mutations cause the most cases of hereditary breast cancers, but genetic counselors will look at other genes. Mutations in the PTEN and TP53 genes also can cause a higher risk of breast cancer. If the test comes back positive for a mutation, the patients will meet with a surgeon who will discuss their potential options:
Heightened surveillance: Here, a mastectomy is not performed at the time. Instead, a high-risk team will keep tabs on you. The process includes:
Breast self-awareness beginning at 18 years old
Clinical breast exams every 6-12 months, beginning at age 25
Annual MRI, beginning at age 25
Annual mammograms beginning at age 30
Risk-reducing medicines, such as tamoxifen
Risk-reducing mastectomy: This procedure removes breast tissue and potentially more.
Dr. Janfaza says the surgical team will thoroughly talk through the options, providing the risks and benefits of both treatments. A mastectomy is a treatment for some patients who have breast cancer. A risk-reducing mastectomy is a potentially preventive surgery to reduce your future risk. Some patients might be unsure about getting one – it’s a personal decision. “A lot goes into these patients choosing to get this risk-reducing mastectomy,” Dr. Janfaza says. “Mentally, emotionally, their reconstructive options. It’s a pretty massive thing for them to undertake. Ultimately, we’re doing this to save their lives.”