Options for women who have an increased risk of breast cancer
Although this section is about risk-reducing breast surgery, there are several options for women who have an increased risk of developing breast cancer.
Regular breast screening
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This involves regular mammography (breast x-rays) and/or MRI scans (scans that use a magnetic field to build up a picture of the breasts).
Regular breast screening can help to find breast cancer at an early stage, but it won’t prevent it. Breast cancers found at an early stage are often curable.
UK guidelines recommend that women are offered yearly mammograms if they are aged 40–49 and have an increased risk of developing breast cancer. They also recommend that MRI scans should be available to some women under the age of 50 who are at a greatly increased risk of developing breast cancer.
If you aren’t having regular screening and think you should be, talk to your GP. Your GP will be able to assess your risk and may refer you to a genetic clinic for further assessment and advice about screening and treatment to reduce your risk (if you need it).
To find out more about early detection and screening, you could read our section on breast screening or breast screening in women under 50 with a family history of breast cancer.
Removal of the ovaries and fallopian tubes
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Surgery can be carried out to remove both the ovaries and fallopian tubes to reduce the risk of cancer developing. This proceudre is also called risk-reducing bilateral salpingo-oophorectomy.
Women who inherit the BRCA1 or BRCA2 faulty genes have a higher risk of developing both ovarian and breast cancer. Risk-reducing bilateral salpingo-oophorectomy may sometimes be used to reduce the risk of ovarian and breast cancer in women who have inherited the BRCA faulty genes. It may be offered in addition to risk-reducing mastectomy rather than instead of it.
As surgery to remove the ovaries makes a woman infertile, risk-reducing bilateral salpingo-oophorectomy is usually only carried out when a woman has completed her family. After surgery, hormone replacement therapy (HRT) is usually given until the time a woman would normally expect to have her menopause. This is to prevent menopausal symptoms. In this situation, the use of HRT does not increase the risk of breast cancer.
Your specialist team will be able to tell you more about this type of surgery and discuss whether it’s suitable for you.
Using drugs to prevent breast cancer (chemoprevention)
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Some drug treatments, such as tamoxifen and raloxifene, can help to reduce the risk of breast cancer in women who have a higher than average risk. However, doctors still don’t know how effective these are in preventing breast cancer in women with BRCA mutations.
Drugs that may reduce the risk of breast cancer can also cause side effects so it’s important to weigh up the risks and benefits of these treatments. Research is being carried out to find drugs that can reduce the risk of breast cancer and cause fewer side effects.
Your hospital team will be able to tell you if you might benefit from taking drug treatments to reduce your risk of breast cancer. They can also give you information about any trials that are testing drugs to prevent breast cancer.
Find out more about clinical research trials.
Risk-reducing mastectomy and breast cancer risk
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It’s important to remember that not all women who have an increased risk of developing breast cancer will actually develop it. Some women who choose to have risk-reducing breast surgery may never have developed breast cancer anyway.
However, there is currently no way of knowing whether an individual woman will develop breast cancer or not. For some women, risk-reducing breast surgery helps relieve their anxiety and lessen their fears about developing breast cancer.
It’s impossible for surgeons to remove every single breast cell during a mastectomy. Usually about 95% of the breast tissue is removed. Because a small amount of the breast tissue is left behind after surgery, risk-reducing mastectomy won’t completely remove the risk of developing breast cancer.
Research has shown that bilateral risk-reducing mastectomy can reduce the risk of breast cancer in women who have mutations in the BRCA1 and BRCA2 genes by as much as 95%. So, although the surgery doesn’t completely get rid of the risk, it does greatly reduce it.
Some experts believe that after risk-reducing breast surgery the chance of developing breast cancer is less than 5% (1 in 20). This means that after having this surgery, a woman’s chance of developing breast cancer may be less than that of a woman in the general population. The lifetime risk of a woman in the general population developing breast cancer is about 12% (1 in 8).