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Preventive surgery for high-risk women.

Having breast tissue removed before cancer is detected sounds drastic. However, for high-risk women who have watched mothers, sisters, aunts, and other close relatives lose their lives to the disease, the procedure may start as a radical notion, but often turns into a serious option.

Preventive subcutaneous mastectomy, an operation which removes breast tissue cells as a way to prevent cancer cells from developing, is gaining renewed popularity and credence in some circles as a valid prevention mechanism, notes Alan Hollingsworth, breast surgery specialist and research director for the Institute for Breast Health, University of Oklahoma Health Sciences Center. Although such surgery has been performed since the 1970s, it remains highly controversial. "This is because there have never been any controlled scientific studies of its effectiveness, no professional agreement on the indications, and there is no standardized way to perform the surgery. Also, for several years, some surgeons were suggesting that lower-risk women and women with painful lumps have their breast tissue removed. As a result of poor scientific controls, mixed results of the procedure's effectiveness began appearing in the medical journals."

Hollingsworth feels preventive mastectomy is warranted in cases where a woman clearly is at a very high risk (nine to 10 times that of the general population) for developing breast cancer. This level occurs when a pre-menopausal woman has both a strong family history of breast cancer and a biopsy revealing premalignant cells. Such a patient may be at a 40% lifetime risk of breast cancer, and thus may be unimpressed with the "hoped for" one-third risk reduction that may be offered by current anti-estrogen hormone therapy trials.

"The other, absolutely vital, element is that the woman wants to have the procedure. Some women are devastated by the idea of preventive breast surgery. For others, who have watched close relatives die of the disease, anything which can alleviate some of the anxiety is a blessing. These are women who think about breast cancer every day, and the psychological relief this operation provides is incredible."

Two types of preventive mastectomy currently are performed. The first (and less popular) is a bilateral procedure, wherein the nipple is removed, leaving the appearance of a modified radical mastectomy. Although it is cosmetically less pleasing, it is more effective as a cancer deterrent, because all of the breast tissue is cut out.

The second, a bilateral subcutaneous mastectomy, removes breast tissue through a small incision, leaving the nipple intact, and replacing tissue with a saline implant or transferred muscle. Although it is cosmetically superior, and therefore more popular with patients, this method is less successful as a cancer deterrent because some breast tissue remains. "In a high-risk patient, this procedure does improve the odds of avoiding breast cancer. However, these women should continue to have follow-up exams, to make sure the remaining tissue does not become cancerous," Hollingsworth cautions.
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Title Annotation:breast cancer
Publication:USA Today (Magazine)
Date:Feb 1, 1993
Words:476
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