SIDEBAR: Expect Questions about Preventive Double Mastectomies  


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For women who are considering prophylactic bilateral mastectomies, “I strongly encourage genetic testing, Todd M. Tuttle, MD, MS, said in an interview with The ASCO Post about the increased interest in preventive double mastectomy following Angelina Jolie’s disclosure that she had the procedure to reduce her risk of breast cancer. In a New York Times article entitled “My Medical Choice,”1 Ms. Jolie explained that she had an identified BRCA1 mutation and an estimated 87% risk of breast cancer, as well as a 50% risk of ovarian cancer.

“The majority of the patients for whom I perform bilateral prophylactic mastectomy are those who have an identified gene mutation,” Dr. Tuttle added. “I do see people who think they are at increased risk and come in and talk about having bilateral mastectomies, and I usually will have them make sure we know their family history well and perform genetic testing when appropriate.” Dr. Tuttle is Chief of the Division of Surgical Oncology at the University of Minnesota in Minneapolis and Medical Director of the University of Minnesota Breast Center.

Recommendations

According to the National Comprehensive Cancer Network (NCCN) Guidelines for Breast Cancer Risk Reduction:

Risk reduction mastectomy should generally be considered only in women with BRCA1/2, or other strongly predisposing gene mutation, compelling family history, or possibly with [lobular carcinoma in situ] or prior thoracic radiation therapy at < 30 y of age. Women considering risk reduction mastectomy should receive multidisciplinary counseling including consultation with genetics if not already done. Psychological consultation may also be of value.2

Disclosure: Dr. Tuttle reported no potential conflicts of interest.

References

1. Jolie A: My medical choice. New York Times, May 14, 2013.

2. National Comprehensive Cancer Network: NCCN Guidelines: Breast cancer risk reduction, version 1.2013. Available at www.nccn.org. Accessed June 5, 2013.


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