Assessment of Breast Cancer Risk Before Surgery Improves Outcomes

A new study offers guidelines for plastic surgeons to help women gauge their breast cancer risk, and offer the best options for surgical intervention and reconstruction.

Researchers at Case Western Reserve University (Cleveland, OH, USA) reviewed the current information and clinical tools needed to help plastic surgeons in identifying high-risk patients who would benefit from genetic testing and counseling. Among the guidelines included are recommendations that: 1) Prior to every elective breast surgery, special attention should be paid to any family history of breast or ovarian cancer; patients who are at high risk for breast cancer based on their personal and family history should be referred for further evaluation by a medical oncologist and/or geneticist. 2) Every woman 40 years of age and older should have a mammogram prior to an elective breast procedure. Some even recommend a preoperative mammogram in all women undergoing cosmetic breast surgery.

Ultrasound studies and magnetic resonance imaging (MRI) may be used to further evaluate patients with difficult or unsatisfactory mammograms. 3) Since breast augmentation, reduction, mastopexy (breast lift), and implants may have significant consequences in screening and surveillance of breast cancer, specifically with regard to future mammographic evaluation, a new mammogram should be obtained three-to-six months after surgery, to serve as the new baseline for evaluation.

The authors recommend that women with high-risk factors for breast cancer early onset (BRCA) 1 and 2 mutations--which account for 5% to 10% of breast cancer cases--should be referred to a medical oncologist and geneticist for counseling. Early intervention with these particularly high-risk women means that they could choose from more surgical and reconstructive options. Many high-risk women with no current signs of breast cancer, for example, are excellent candidates for types of prophylactic surgery such as skin sparing mastectomy or nipple sparing mastectomy. The risk of developing breast cancer can be cut by 90% in these high-risk women through bilateral prophylactic mastectomy. Reconstruction procedures performed simultaneously can also provide excellent cosmetic results for the patient. The authors stress that it is important for plastic surgeons to be involved in the treatment planning to discuss placement of biopsy and mastectomy incisions, and also to adequately discuss realistic aesthetic expectations with the patient. The study was published in the January/February 2008 issue of the Aesthetic Surgery Journal.

"Genetic testing, such as that for BRCA1 and BRCA2, has allowed clinicians to better tailor risk management strategies in patients from families with hereditary breast cancer,” said co-author Hooman Soltanian, M.D. "Plastic surgeons are in a unique position to provide early preventative options to their patients.”


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Case Western Reserve University