Thousands of cancer cases could potentially be prevented if more women were offered breast removal surgery, according to a study. A mastectomy is offered to some people who already have breast cancer, but research suggests about 6,500 cases could be prevented each year if more preventative procedures were done.
Risk-reducing mastectomies (RRM) are currently only an option for women with the BRCA1, BRCA2, PALB2 genes. But the study says people with other genes – including ATM, CHEK2, RAD51C, RAD51D – might benefit if they also have other high-risk factors. These include family history of the disease, whether they breastfed, mammogram density, and the number of children they’ve had.
Researchers suggest that if all women aged 30 to 55 with a risk of 35% or more could be identified – and they all then had RRM – an estimated 6,538 cases could be prevented each year. That equates to about 11% of the 59,000 UK women diagnosed annually.
The economic evaluation by Queen Mary University of London and the London School of Hygiene and Tropical Medicine (LSHTM) said it would be a cost-effective strategy. It added that women carrying one of the other genes linked to breast cancer could potentially be found by «cascade testing», in which tests are offered to family members.
One of the authors said it was the first time a risk factor for offering RRM had been defined. «Our results could have significant clinical implications to expand access to mastectomy beyond those patients with known genetic susceptibility in high penetrance genes – BRCA1/ BRCA2/ PALB2 – who are traditionally offered this,» said Professor Ranjit Manchanda, professor of gynecological oncology at Queen Mary. «We recommend that more research is carried out to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group,» he added.
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Louise Grimsdell, Breast Cancer Now senior clinical nurse specialist, stressed that women should consider all options – not just surgery. «While this modeling provides valuable insights into the cost-effectiveness of risk-reducing mastectomy for women with a high risk of developing breast cancer, each individual must be offered all risk-management options that are suitable for them,» she said. «Choosing to have risk-reducing surgery is a complex and deeply personal decision that comes with emotional and physical implications,» added Ms. Grimsdell. «So, it’s vital women can consider all their options, including screening and risk-reducing medications, and are supported by their clinician to make an informed decision that’s right for them. It’s also crucial that the unacceptably long waits that far too many women who chose risk-reducing surgery are facing are urgently tackled.»
The study appears in the journal JAMA Oncology.
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