According to da Costa et al. (2017), globally, 1.7 million breast cancer cases are diagnosed annually. There is no single identifiable cause of breast cancer. However, several environmental, hormonal, and genetic factors increase the risk of its development. As such, it remains essential for women at high risk to be identified. Early identification of breast cancer results in a high cure rate, of more than 90% (Walsh et al., 2016). Over 200,000 survivor patients in the U.S. had developed breast cancer, primarily from genetic predisposition (Walsh et al., 2016).
Of all the breast cancer cases, 10% to 30% are associated with hereditary factors (Costa & Saldanha, 2017). Genetic testing is carried out to identify the susceptibility risk of individuals predisposed to hereditary diseases such as breast and ovarian cancers. Genetic markers provide an accurate prediction of the risk of disease development. BRCA1 and BRCA2 genetic mutations are responsible for the majority of inherited breast cancer cases, accounting for more than 50% (Costa & Saldanha, 2017). Mutations in BRCA1 have an estimated lifetime risk of 65% to 87%, while BRCA2 mutations have an associated 45% to 84% risk (Smeltzer et al., 2008).
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Development of breast cancer is highly inevitable in women whose tests turn positive for all the genetic markers for breast cancer. In such cases, preventing cancer development is the best way to go. Several preventive approaches exist, including chemoprevention and prophylactic mastectomy. Chemoprevention refers to medication use to prevent cancer development in high-risk patients and provides a 49% reduction rate (Hinkle & Cheever, 2018). Tamoxifen and Raloxifene are the commonly used drugs but are associated with risk factors such as blood clots formation and the development of cataracts.
Bilateral mastectomy refers to both breasts' surgical removal to prevent the development of cancer in women at a high likelihood, especially those with identified genetic mutations. Prophylactic mastectomy lessens the likelihood of developing breast cancer by more than 90% to 95% (Smeltzer et al., 2008). Breast reconstruction follows mastectomy to restore breasts' appearance.
According to a research by Meijers-Heijboer et al. (2001), 136 women who had mutations in BRCA1 and BRCA2 genes were recruited to determine the incidence of breast cancer development following either surveillance or prophylactic mastectomy. There was no breast cancer development in all the women who underwent prophylactic mastectomy, as opposed to 8 breast cancer cases out of the 63 women under surveillance. In another study by Alaofi, Nassif & Hajeili (2018), out of 257 women at a high risk underwent prophylactic mastectomy, there was no breast cancer case reported for the period of 14 years which they were under follow up. The studies provide a clear and more profound insight into the efficiency and effectiveness of prophylactic mastectomy.
It would be hard to tell which breast is likely to develop cancer in an exposed woman. As such, both breasts should be removed to be sure of positive outcomes. Bilateral mastectomy has been shown to have an 85% to 100% risk reduction rate (Alaofi, Nassif & Hajeili, 2018) and also reduces the risks of other malignancies in the body.
Additionally, mastectomy remains the best cancer prophylactic choice in most situations. For some reason, women at risk may not be able to use chemoprevention or radiation therapy as preventive strategies. Moreover, many prefer undergoing surgery to having repeated sessions of radiation therapy. Radiation therapy only lowers the risk of cancer development by a low margin. A bilateral mastectomy would be the safest procedure in pregnancy. Radiation therapy and chemoprevention would expose the fetus to harm.
Conditions such as systemic lupus erythematosus make patients more susceptible to the side effects of radiation therapy. Therefore, a bilateral prophylactic mastectomy remains the best solution in such patients.
Women showed satisfaction rates ranging from 70% to 90% following mastectomies (Alaofi, Nassif & Hajeili, 2018). However, they were still concerned about their body appearance. The women are also affected socially and psychologically. These issues can be managed using a collaborative management approach. Before deciding for a preventive mastectomy, should be provided with the essential information, what to expect postoperatively, and how the issues can be handled.
In conclusion, studies have elaborated on the effectiveness and low morbidity rates of prophylactic mastectomy as a preventive approach for breast cancer in susceptible women. Therefore, those at risk should be provided with clarification, information, and support in making decisions if they opt for prophylactic mastectomy.
References
Alaofi, R. K., Nassif, M. O., & Al-Hajeili, M. R. (2018). Prophylactic mastectomy for the prevention of breast cancer: Review of the literature. Avicenna journal of medicine , 8 (3), 67–77. https://doi.org/10.4103/ajm.AJM_21_18
Costa, M., & Saldanha, P. (2017). Risk reduction strategies in breast cancer prevention. European journal of breast health , 13 (3), 103.
da Costa Vieira, R. A., Biller, G., Uemura, G., Ruiz, C. A., & Curado, M. P. (2017). Breast cancer screening in developing countries. Clinics , 72 (4), 244-253.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing . Wolters kluwer india Pvt Ltd.
Meijers-Heijboer, H., van Geel, B., van Putten, W. L., Henzen-Logmans, S. C., Seynaeve, C., Menke-Pluymers, M. B., ... & Brekelmans, C. T. (2001). Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. New England Journal of Medicine , 345 (3), 159-164.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., Cheever, K. H., Townsend, M. C., & Gould, B. (2008). Brunner and Suddarth’s textbook of medicalsurgical nursing 10th edition . Philadelphia: Lipincott Williams & Wilkins.
Walsh, M. F., Nathanson, K. L., Couch, F. J., & Offit, K. (2016). Genomic Biomarkers for Breast Cancer Risk. Advances in experimental medicine and biology , 882 , 1–32. https://doi.org/10.1007/978-3-319-22909-6_1
