Prophylactic Mastectomy: still a controversial procedure?

• Autor(a) principal: Vaz, Fátima
• Data de Publicação: 2014
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spcir.com/index.php/spcir/article/view/329

The follow up and care of BRCA1/2 women, and the decisions concerning risk reduction strategies, challenge the classical patient-doctor relationship. Non-directive counseling with open discussion about different alternatives for breast cancer risk reduction is usually recommended. Scientific evidence in this field is complex, due to the lack of randomized data and heterogeneous selection criteria for different studies. The physicians in charge of this follow up must be aware of the latest scientific data, to allow for an informed discussion with their patients. Decisions must be tailored taking into account individual factors. Surgical prevention (prophylactic mastectomy and/or oophorectomy) reduces the risk of invasive breast cancer in BRCA and BRCA2 patients, with prophylactic mastectomy (PM) being the most effective procedure for cancer prevention, in these women. Although effective in this setting, prophylactic surgery is still criticized because it could be non-therapeutic and only decided on the family history or clinical decision. With generalization of commercial BRCA1 and BRCA2 screening, a more accurate selection of candidates for PM is possible. Acceptance of this procedure by women at risk and health practitioners is variable. We suggest that risk management of these high-risk women must be done by multidisciplinary teams. Keywords: breast cancer, BRCA1, BRCA2, prophylactic mastectomy.