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BreastCentre Zurich

Hereditary predisposition is the cause of 10 to 15 per cent of all breast and ovarian cancers. 50 per cent of these are due to a mutation in the BRCA-1 and BRCA-2 genes, although mutations in other risk genes are also responsible for a familial clustering of breast and ovarian cancers. In the case of hereditary increased cancer risk, affected patients can receive detailed advice on the surgical options for risk reduction during a consultation.

Preventive mastectomy

Around 10 to 15 per cent of all breast cancers are caused by genetic changes. These changes significantly increase the risk of developing breast cancer compared to a person without these genes. This becomes apparent, for example, through a clustering of breast cancer, but also other types of cancer such as ovarian cancer, bowel or prostate cancer in the family and can be detected using genetic tests.

The most common genetic changes that increase the risk of breast cancer are BRCA-1 and BRCA-2. Other changes that increase the risk of breast cancer occur less frequently and affect genes such as PALB2, ATM, TP53, CDH1, CHEK2, RAD51C and RAD51D.

A preventive or risk-reducing mastectomy means the complete removal of breast tissue without a confirmed case of breast cancer at the time of the operation. It should be considered if a patient has a hereditary increased risk of developing breast cancer. The aim of the operation is to significantly reduce the risk of developing breast cancer. The literature indicates a reduction in the probability of developing the disease of 85 to 95 per cent.

This form of preventive mastectomy due to a family history of cancer and subsequent reconstruction places high demands on aesthetics and durability. The mastectomy can be performed together with reconstruction. In this case, only the gland is removed and the breast skin remains intact. All reconstruction procedures can be used here, both with implants and with the patient's own tissue. With certain reconstruction techniques, both breasts are reconstructed at the same time. With other techniques, both sides can be operated on at different times. We will be happy to advise you on mastectomy surgery and reconstruction in a personal consultation. As experts in breast reconstruction and based on our experience, we can offer you all breast reconstruction procedures. We will be happy to discuss which one is most suitable for you.

Preventive removal of the ovaries and fallopian tubes

Some of the genetic mutations can also increase the risk of developing ovarian cancer (ovarian carcinoma), in particular BRCA-1 and 2, where the risk is increased to 30 to 50 per cent for BRCA-1 and 10 to 30 per cent for BRCA-2 compared to the normal population (approx. 1.5 per cent lifetime risk). The risk of ovarian cancer is also increased in certain forms of Lynch syndrome (mutations in MLH1, MSH2, MSH6) and mutations in the RAD51C, RAD51D and BRIP1 genes. Prophylactic removal is therefore recommended. Other gene mutations that increase the risk are being evaluated on the basis of new information, meaning that recommendations can change constantly and counselling should always be based on the latest scientific data. In some cases, no genetic mutation is found, but several family members are affected. Even then, a risk-reducing operation may be an option. The most data is available for BRCA-1 and 2: prophylactic removal of the adnexa (ovaries and fallopian tubes) can reduce the risk of developing ovarian cancer by 80 to 90 per cent. The overall mortality rate is also reduced by 68 per cent. If the operation is performed before the menopause, this also appears to have a positive effect on the risk of breast cancer, particularly for BRCA-1 patients in the longer term.

The optimal age for preventive removal of the adnexa depends on the mutation present, but also on the age at which family members were diagnosed. In principle, for BRCA mutations, removal is recommended after family planning has been completed or between the ages of 35 and 40 for BRCA-1 and between the ages of 40 and 45 for BRCA-2. For moderate risk genes, surgery is justifiable at the age of 50.

Bilateral removal of the ovaries and fallopian tubes is usually performed by laparoscopy and is a standard operation. The average length of hospitalisation is two days. Due to the keyhole surgery, the wounds are small and patients usually recover quickly. In forms of Lynch syndrome with an increased risk of ovarian cancer, the risk of uterine cancer is also increased, which is why removal of the uterus is also recommended in these cases.

Non-hormonal and hormone replacement therapies are available to counteract the hormone withdrawal symptoms of the early menopause caused by the removal of the ovaries. In BRCA 1 and 2 patients who had their ovaries removed before the age of 45, hormone replacement therapy does not increase the risk of breast cancer compared to BRCA patients who did not receive hormone replacement therapy.

Prophylactic removals information sheet


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