To Your God Health: When double mastectomies are necessary

DEAR DR. ROACH: I know women who have had double mastectomies in order to reduce the risk of cancer. It seems extreme, but I guess it depends on the evaluation of risk. Are prophylactic hysterectomies done for similar reasons? It used to be routinely done when a woman had passed her reproductive years. I’m interested in your take on this. Will health insurance cover these types of surgeries, and if not, how expensive are they? — S.B.

ANSWER: Prophylactic mastectomies — that is, surgery to remove the breasts in order to avert a breast cancer diagnosis — are a reasonable choice for some women at very high risk of breast cancer, especially those with a family history of breast cancer who have an identifiable genetic predisposition, such as one of the BRCA gene mutations. This decision should be made carefully and in consultation with her doctors, usually an oncologist and a genetic counselor. I have very little experience with this in my own patients, fortunately, but I understand that in the case of women with very high genetic risk, it usually is covered by insurance, if it is the consensus of the treating physicians and the patient that she should proceed.

Hysterectomy — the removal of a uterus — is not done routinely today, the way it was decades ago. They are removed for disease, either benign or malignant. However, the removal of both ovaries and Fallopian tubes, called a bilateral oophorectomy and salpingectomy, is performed in some women at high risk for ovarian cancer. In fact, women with the BRCA mutations may consider both a prophylactic double mastectomy and a prophylactic bilateral oophorectomy and salpingectomy, since BRCA mutations increase risk of breast cancer and ovarian cancer (as well as other cancers).

The cost of surgery in the United States varies dramatically depending on where it is done, but in general it is very expensive.

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