Risk-reduction mastectomy: clinical issues and research needs.
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.
Stefanek
M
M
Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. ms496r@nih.gov
Hartmann
L
L
Nelson
W
W
D016588:Anticarcinogenic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D005260:Female; D019398:Genes, BRCA1 / Q000235:genetics; D016147:Genes, Tumor Suppressor / Q000235:genetics; D006579:Heterozygote; D006801:Humans; D015994:Incidence; D008327:Mammography; D008408:Mastectomy; D009154:Mutation; D010052:Ovariectomy; D011159:Population Surveillance / Q000379:methods; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012306:Risk; D013629:Tamoxifen / Q000627:therapeutic use
D016588:Anticarcinogenic Agents; D020847:Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride