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Back to opinion_2013_05_15_razonesmastectomiapreventiva
Marta Santisteban Eslava, specialist doctor of the area Breast Cancer Department of the Clínica Universidad de Navarra
Reasons for preventive mastectomy
The main reason why a person can undergo a preventive mastectomy (removal of the breasts) is if he or she is a carrier of a mutation Genetics manager for breast cancer, even if he or she has not yet developed it. In these people, the chances of manifesting the disease are very high, since they are between 80 and 90% of the cases that present the alteration Genetics.
In global terms, hereditary origin accounts for 8% of all breast tumors. The remaining 92% are not caused by Genetics. Of this hereditary 8%, the majority corresponds to the presence of mutations in the BRCA1 or BRCA2 genes, although other genes may be involved, although they are less frequent. To determine the existence of this mutation manager of the development of a breast and/or ovarian tumor, it is necessary to perform a molecular analysis of peripheral blood.
Initially, two options can be recommended for people who have already been found to be carriers of the mutation in one of these two genes. One consists of very close monitoring for early detection of the disease. In the case of the breast, early detection programs using imaging tests have already proven to be effective. In this case, a follow-up every 6 months is usually recommended, during which mammography and breast ultrasound are alternated with breast MRI at the next check-up. However, there is a risk of developing a cancer in the interval between one screening and another, so the disease is not prevented, although a very early diagnosis is facilitated. The second alternative for those who carry this mutation is the performance of a mastectomy (complete removal of the breasts). This is a more radical option, but more effective. The person is usually left with more peace of mind, since the risk of developing the disease is reduced by more than 85%. However, it should be emphasized that the risk is not completely eliminated either, given the difficulty of removing all the glandular tissue.
Preventive mastectomy and breast reconstruction are usually performed in the same surgical procedure, so the psychological impact on the woman is less. However, the presence of the aforementioned genetic mutations - BRCA1 and BRCA2 - also implies a high risk, not only of breast cancer (also in men), but also of ovarian cancer. The added problem with this tumor is that there is no effective early detection technique. In ovarian cancer, a gynecological ultrasound scan can be performed in addition to the determination of the CA-125 marker, but its effectiveness in early detection has not been demonstrated. For this reason, ovarian cancer is usually diagnosed in advanced stages. Thus, when a woman presents one of the two genetic mutations, BRCA1 or BRCA2, in addition to mastectomy, removal of the ovaries is usually recommended (preferably, once maternity is satisfied) and part of the fallopian tubes. The latter is not an excessively complex surgery since it is a laparoscopic intervention.