Options for women with a high risk of developing breast cancer

There are several ways to manage a high risk of breast cancer. Each option has advantages and disadvantages. Your specialist team can talk these through with you.

  • Breast screening – Having regular breast x-rays and breast scans can help to detect breast cancer at an early stage when it is often curable. Breast screening can’t prevent breast cancer.
  • Surgery to remove the ovaries and fallopian tubes – Women with the BRCA1 or BRCA2 faulty genes have an increased risk of ovarian and breast cancer. Having an operation to remove the ovaries and fallopian tubes reduces the risk of both cancers. The operation causes infertility so it is only done after a woman has completed her family.
  • Taking drugs to prevent breast cancer – Some drugs can help reduce the risk of breast cancer in some women. This is called chemoprevention.
  • Risk-reducing mastectomy – This surgery reduces the risk of developing breast cancer by up to 95%. It’s not possible to remove breast tissue completely so a small risk of getting breast cancer remains.

Regular breast screening

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.

The National Institute for Health and Care Excellence (NICE) is an independent body that gives guidance to doctors on the prevention and treatment of ill health in England and Wales.

Guidelines for England and Wales and Scotland 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.

To find out more about early detection and screening, you may find it helpful to read our information about breast screening and breast screening in women under 50 with a family history of 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 on screening and treatment to reduce your risk if this is needed.


Risk-reducing bilateral salpingo-oophorectomy

This is when surgery is carried out to remove both the ovaries and fallopian tubes to reduce the risk of cancer developing.

Women who inherit the BRCA1 and 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 also 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, 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)

Some drug treatments, such as tamoxifen and raloxifene, can help to reduce the risk of breast cancer in some women who have a higher than average risk. 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.

Your hospital team will be able to tell you if you might benefit from taking drug treatments to reduce your risk of breast cancer.


Risk-reducing mastectomy and breast cancer risk

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. However, there is currently no way of knowing whether an individual woman will develop breast cancer or not. For some women, having risk-reducing breast surgery helps to relieve their anxiety and lessen their fears of 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).


Back to Risk-reducing breast surgery

What happens after surgery?

Recovery can take some time after risk-reducing breast surgery. It will depend on the type of surgery you have had.