Should I Consider Preventive Mastectomy After Previous Breast Cancer?

If one breast has been removed and the opposite breast frequently shows calcifications that require monitoring, is it possible to perform a prophylactic mastectomy?

Hello Dr.
Lai, I am 45 years old.
In 2012, I was diagnosed with stage 2A breast cancer in my left breast and underwent a total mastectomy.
I have been taking Tamoxifen for three years.
Recently, during my regular follow-ups every three months, ultrasounds and mammograms have shown suspected cysts or fibroadenomas and calcifications.
The calcifications have always been present, while the suspected cysts or fibroadenomas sometimes go undetected but may reappear in subsequent exams.
During my last visit, my doctor adjusted my follow-up schedule to have an ultrasound every three months and a mammogram every three months thereafter.
I feel this is a cautious approach to monitoring, even though the imaging appears benign.
Since the left breast was removed in 2012, I also underwent partial lymph node dissection, which has left my left arm unable to bear weight.
Most of my tasks rely on my right hand.
I have been contemplating whether it is worth undergoing mammograms every few months, given the exposure to X-ray radiation.
It seems I may have to continue this monitoring for life, and the radiation exposure is not good for my body.
Moreover, if the right breast were to develop malignancy like the left breast did after seven years of monitoring, it would result in another mastectomy, affecting the function of my right hand and significantly impacting my quality of life.
My husband and I feel that the remaining right breast holds little personal significance and only serves to cause anxiety.
Should I consider undergoing a prophylactic mastectomy of the right breast? It seems like a preventive measure, but such preventive treatments are not widely supported in Taiwan.
Most practitioners prefer to wait until there is a definitive issue before proceeding with treatment.
Personally, I believe that a prophylactic mastectomy is a minor procedure, and if there is indeed a problem later, surgery would be necessary, potentially affecting the lymph nodes as well.
I am extremely confused and would greatly appreciate any advice you could provide.
Thank you!

Ms. Hu, 40~49 year old female. Ask Date: 2016/04/21

Dr. Lai Yicheng reply Oncology

Dear Ms.
Hu,
In response to your inquiry, I find it challenging to answer your question.
Similar to American actress Angelina Jolie, who underwent prophylactic mastectomy, there are differing opinions within the medical community, and perspectives vary.
I recommend discussing this further with your physician.
My advice for you is to closely monitor your right breast.
Additionally, consider increasing your intake of lycopene, an antioxidant nutrient known for its ability to eliminate free radicals, which is twice as effective as other types of carotenoids and a hundred times more effective than vitamin E.
Lycopene is found in many foods, such as tomatoes (the redder, the higher the content), grapefruit, watermelon, papaya, mango, and carrots.

To maximize lycopene intake from tomatoes, the method of preparation is crucial.
Since lycopene is located within the cell walls, mechanical processing can help release it more effectively.
Consuming canned tomato products or tomato juice (look for those labeled as pure juice, high in lycopene, and low in sodium) or cooking tomatoes (with oil or vinegar) can significantly increase the amount of lycopene absorbed compared to eating raw tomatoes.
Changhua Hospital cares about you.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2016/04/21

More Info

When considering preventive mastectomy after a previous breast cancer diagnosis, there are several important factors to weigh. Your situation, having been diagnosed with stage 2A breast cancer in 2012 and undergoing a total mastectomy of the left breast, places you in a unique position regarding your health and future risks.
Firstly, it’s essential to understand the rationale behind preventive mastectomy, often referred to as prophylactic mastectomy. This procedure is typically considered for individuals with a significantly elevated risk of developing breast cancer, such as those with BRCA1 or BRCA2 gene mutations or a strong family history of breast cancer. The goal is to reduce the risk of developing cancer in the remaining breast tissue. Given that you have already had breast cancer, your risk of developing a new primary breast cancer in the opposite breast is higher than that of the general population, but it is still essential to evaluate your specific risk factors.

In your case, you mentioned the presence of cysts, fibroadenomas, and calcifications in your remaining breast, which have been monitored through regular imaging. While these findings can be concerning, it’s important to note that many women have benign conditions that do not progress to cancer. The decision to undergo preventive mastectomy should be made after careful consideration of your current health status, the nature of the findings in your right breast, and your personal feelings about the risks involved.

You expressed concerns about the cumulative radiation exposure from regular imaging and the potential for future malignancy in the right breast. While it is true that repeated imaging does involve some level of radiation exposure, the risk associated with this is generally considered low compared to the potential benefits of early detection of any changes. Regular monitoring is crucial, especially given your history, as it allows for timely intervention if any concerning changes occur.

If you are feeling overwhelmed by the anxiety of living with the remaining breast and the fear of recurrence, it is understandable that you would consider preventive mastectomy. However, it is crucial to have a thorough discussion with your healthcare team, including your oncologist and possibly a genetic counselor, to assess your individual risk factors and the implications of such a decision. They can provide insights into the likelihood of recurrence based on your specific pathology and imaging results.

Additionally, consider the emotional and psychological aspects of living with the fear of cancer recurrence. Some women find peace of mind in having a preventive mastectomy, while others may prefer to continue with regular monitoring. It may also be beneficial to seek support from a mental health professional or a support group for breast cancer survivors, as they can provide valuable perspectives and coping strategies.

In summary, the decision to pursue preventive mastectomy is highly personal and should be made based on a comprehensive evaluation of your individual risk factors, the nature of your current breast condition, and your emotional well-being. Engaging in open and honest discussions with your healthcare providers will help you make an informed decision that aligns with your values and concerns.

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