Commentary: Bilateral risk-reducing mastectomy is the safest strategy in BRCA1 carriers

Frontiers in Psychology

Rachael Glassey¹ 

关键词: familial cancer;    bilateral prophylactic mastectomy;    risk management;    counseling;    psychological support;   

DOI  :  10.3389/fpsyg.2017.00121

学科分类：心理学（综合）

来源: Frontiers

【 摘 要 】

Pilgrim and Pain (2014) suggest the best option for BRCA1 carriers is to undergo a bilateral prophylactic mastectomy (BPM). Pilgrim and colleagues suggest that a BPM combined with salpingo-oophorectomy at 25 years old is the best option to minimize risk of developing breast cancer (BC) and ovarian cancer. Undergoing BPM may be the safest option to reduce incidence and mortality, however a diagnosis of a BRCA mutation does not confer a 100% risk and BPM is not the only risk management option. The risk (to 70 years) of developing BC for a BRCA1 carrier is estimated to be about 60% (Mavaddat et al., 2013) and it has been suggested women with BRCA mutations may have up to 80% lifetime risk (National Cancer Institute, 2013). We contend BPM it is not necessarily the best option for all women, especially at such a young age and without a process of fully informed and supported decision-making. The purpose of the current paper is to highlight that health professional recommendations to undergo a BPM may lead to patient regret and clinician blame. Our commentary highlights the consequences of undergoing a BPM without a process of fully informed decision-making, including potential emotional and psychological complications associated with body image and sexuality. We suggest health professionals should provide patients with all options, including screening, medical risk reduction (e.g., tamoxifen) and BPM. We propose all women considering BPM should be referred to an experienced counselor or psychologist to discuss their options, and ensure these individuals are making an informed decision and not one driven by fear or based on the perceived bias of one health professional or other individual, such as anecdotal advice from well-meaning friends or family.

【 授权许可】

CC BY