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...