RISK REDUCING / PROHYLACTIC SURGERY
Patients with an inherited risk for cancer should be advised of the options to reduce their risk. Medications including hormones can be used to reduce risk of cancer. Cancer can be prevented by surgical removal of the tissue at risk to develop cancer. Risk reduction is commonly done to prevent ovarian cancer, uterine cancer, and breast cancer. Birth control pills have long been used to reduce the risk of ovary cancer. This only reduces the risk by 40-50% when used for long periods of time. Birth control pills, a hormone-releasing IUD inside the uterus, or injected hormone such as Depo-Provera can suppress the growth of the endometrium inside the uterus and therefore can markedly reduce the risk of uterine cancer.
Surgery can remove the uterus or ovaries prior to when the cancer would develop. This is commonly considered for high risk individuals once they are finished with childbearing. A patient with an inherited risk for cancer is more likely to develop a cancer after age 35. Surgery can be delayed until childbearing is complete in many cases. Some genetic mutations predispose to both ovary cancer and breast cancer. Ovarian hormone function also aggravates breast cancer risk. Removal of ovaries and fallopian tubes will eliminate the risk of ovarian cancer. Removing ovaries will create early menopause and provides a bonus with a 50% reduction in breast cancer risk.
Dr. Martin is a strong proponent of preventative surgery for gynecologic cancers. Laparoscopy is the most common approach to the surgery so that careful viewing of all the neighboring tissues around the uterus and ovaries can be completed. A safe margin around these tissues must be removed and requires deep understanding of the cancers and their common spread pattern. Up to 5% of these patients with elevated risk may have some early microscopic cancer or precancerous changes found in the normal-appearing tissues. These areas of disease must be identified because they may require therapy. Dr. Martin will communicate with the pathologist about the need for extra sampling of the tissues removed. Surgery is usually completed as an outpatient surgery. Laparoscopy minimizes the healing required and allows a quick recovery. Prophylactic surgery to reduce breast cancer is often a series of multiple procedures including mastectomy and then reconstruction. Patients often find it easier to first complete risk reducing surgery for removal of uterus and ovaries, and later proceed with prevention of breast cancer.
Patients with a high of risk for breast cancer are often treated with removal of all breast tissue. Surgery to remove the breast is called a mastectomy. For this to be beneficial the breast surgery needs to be done prior to the age when breast cancer events begin to happen. Mastectomy and removal of all breast tissue is highly effective for the prevention of breast cancer. Many women wish to pursue breast reconstruction. The mastectomy surgeon will need to coordinate many details with the plastic surgeon who would do reconstruction. A doctor who specializes in breast surgery will complete a preventative mastectomy in a way that optimizes protection against future breast cancer.