Surgery as a Preventive Measure

In a preventive surgery, the surgeon removes tissue that does not yet contain cancer cells, but has the probability of becoming cancerous in the future. This may also be referred to as prophylactic surgery. For example, with the consent of the patient, the surgeon sometimes removes the ovaries of a woman to avoid the risk of ovarian cancer if the person has a very strong family history of ovarian cancer. Based on studies, a woman whose mother or sister had ovarian cancer has a higher than average risk of developing ovarian cancer. The procedure is called prophylactic oophorectomy (removal of both ovaries).

Preventive mastectomy is another example of a surgery with a preventive purpose. In the past, the surgeon may have removed the breast tissue but spared the nipple (subcutaneous mastectomy). Total mastectomy (removal of the entire breast and nipple) is considered in an effort to prevent or reduce the risk of breast cancer. In addition to women who have already had one breast removed due to cancer, preventive mastectomy may also be an option for women with a strong family history of breast cancer, especially if several close relatives developed the disease before age 50. Women in families with hereditary breast cancer who test positive for a known cancer-causing gene alteration (for example, BRCA1 and BRCA2) may also consider prophylactic mastectomy surgery, as may women who have had lobular carcinoma in situ, a condition that increases their risk of developing breast cancer in the same breast and/or in the opposite breast.

Those patients who have a congenital or genetic trait that creates a high risk of developing cancer may benefit from preventive surgery. For example, studies have shown that half of the patients with familial polyposis of the colon, without a preventive colectomy, would develop cancer of the colon by age 40, and all would develop the disease by age 70.

Pros and cons exist for preventive surgeries. Some patients may not choose preventive mastectomy or oopherectomy due to their concerns about with sexual and reproductive function and self-image, even if the procedure may add years to their life expectancy. Due to unique risk factors for cancer of each individual patient, a preventive surgery does not guarantee the patient will never develop cancer. Therefore, the decision of a preventive surgery should only be considered after a careful discussion between the surgeon and the patient.