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Prophylactic Mastectomy
Some women with LCIS who are very
concerned with developing breast cancer (such as those who also have a strong family
history of breast cancer and/or a proven genetic mutation) opt for the preventive removal
of both breasts, a procedure called a prophylactic mastectomy. Research shows
that prophylactic mastectomy markedly reduces a woman’s risk of developing breast
cancer for those at high risk. Prophylactic
mastectomy may be followed by immediate or delayed breast reconstruction.
While a bilateral prophylactic
mastectomy removes the majority of breast tissue and reduces the risk of developing breast
cancer, it is impossible to remove every breast cell. Thus, it is still possible to
develop breast cancer even if both breasts are removed. According to Lynn C. Hartman, MD
of the Mayo Clinic in Rochester, Minnesota, if only three cells are left after a
mastectomy, cancer could develop from those three cells.
In a study conducted by the Mayo Clinic, three
of 214 women who had prophylactic bilateral mastectomies between 1960 to 1993 developed
breast cancer and two of the women later died.
Tamoxifen
The option of taking medication to
reduce breast cancer risk is also available to women with LCIS. In a large clinical
trial conducted by researchers with the National
Surgical Adjuvant Breast and Bowel Project (NSABP), 13,388 women who were at high risk
of developing breast cancer were given either the drug tamoxifen
or a placebo (sugar pill) to determine whether tamoxifen could lower the risk of breast
cancer. All of the women in the study had a
history of LCIS and/or other risk factors for breast cancer (such as a family history or
atypical hyperplasia, an abnormal increase in the number of breast cells, diagnosed by a
previous breast biopsy). The trial revealed a
49% decrease in the incidence of invasive breast cancer in women who were given tamoxifen
in the study compared with women who took the placebo (sugar pill).
As a result of the NSABP trial, the
U.S. Food and Drug Administration (FDA) approved the use of tamoxifen for women at high
risk of breast cancer. Many women with LCIS
take tamoxifen to help prevent breast cancer. Women
with LCIS are encouraged to discuss the possibility of taking tamoxifen with their
physicians.
A second clinical trial by the NSABP
called the STAR trial is currently underway. The STAR is intended to compare the effectiveness
of tamoxifen with raloxifene, a promising new drug that may help prevent breast cancer in
women over age 35 who are at high risk for breast cancer.
The STAR trial is still recruiting participants across the United States and
Canada. Many women with LCIS are eligible to
participate in the STAR trial. Several
centers across the United States are participating in this trial. Click here for more
information on eligibility requirements and how to enroll in the STAR clinical trial.
Additional Resources and
References
Updated: September 12, 2007
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