Angelina Jolie's May 2013 announcement that she had undergone a preventive double mastectomy to decrease breast cancer risk focused media attention on the practice of preventive mastectomy (prophylactic mastectomy). The actress has reported a family history of breast cancer. Her mother had breast cancer and died of ovarian cancer at age 56. Ms. Jolie also revealed that she has a gene mutation in the hereditary breast cancer risk gene BRCA1, placing her in a high-risk group for developing breast cancer in the future.
BRCA1 and BRCA2 are tumor suppressor genes. A mutation in these genes increases a woman's risk of both breast cancer and ovarian cancer. An increase in risk for some other cancers is also possible. While about 12% of women will develop breast cancer in their lifetime, that risk is multiplied fivefold in women with a BRCA mutation. This means that they have about a 60% chance of developing breast cancer. With the availability of testing for BRCA mutations, the incidence of preventive mastectomy (mastectomy in order to prevent from ever developing breast cancer) has dramatically risen in recent years. The procedure can lower the risk of developing breast cancer by up to 90%, according to research studies.
Still, the decision to undergo prophylactic mastectomy is not without controversy. A mastectomy is a major surgical procedure, and all surgery carries some risk of complications. The surgery, even though it substantially decreases breast cancer risk, does not offer a 100% guarantee that breast cancer will be prevented in small areas of tissue that are left behind after the procedure. Other experts point out the relatively high cure rate for breast cancer when detected early and note that women at increased risk can also undergo enhanced and more frequent screening and surveillance. Finally, there are medications that high-risk women can take to decrease (but not eliminate) their cancer risk. This practice is known as preventive therapy or chemoprevention of breast cancer.
Preventive surgery remains the most drastic and likely the most effective option to prevent breast cancer, even if it is not 100% effective. Some women with BRCA mutations undergo preventive, or prophylactic, salpingo-oophorectomy (removal of the ovaries and Fallopian tubes) to reduce their risk of getting ovarian cancer. Prophylactic mastectomy can be accompanied by reconstruction of the breasts to minimize cosmetic changes.
While the costs of major surgery can be high, many private insurance companies cover the cost of preventive mastectomy and reconstructive surgery. However, there are no Federal laws that require that insurers pay for this service, and state laws about coverage requirement may vary. It can be beneficial for your doctor to contact the insurance company to explain why this surgery is necessary in your particular situation.
If you are concerned about your breast cancer risk, your health care professional can help you decide whether you should be tested for BRCA mutations and what type of preventive steps are best for you.
Medically reviewed by Jay W. Marks, MD
"BRCA1 and BRCA2: Cancer Risk and Genetic Testing." National Cancer Institute (NCI). 29 May 2009.
"Facts for Life: Prophylactic Mastectomy." Susan G. Komen for the Cure. 2010.