Even after a prophylactic mastectomy, it is possible for cancer to recur. In this video, Dr. Harness explains that patients should be monitored for recurrence by the multi-disciplinary team that they’re working with.
Dr. Jay K. Harness, MD, FACS: Having a mastectomy is not a guarantee that a cancer cannot reoccur at the mastectomy site. So that is one of the questions I want to deal with here. I often then get asked the question “see Dear Dr. Harness, if I have a prophylactic mastectomy, is that a guarantee that cancer cannot occur in the future at my mastectomy site?” So let me try and deal with both of these questions together.
The chance of a cancer coming back to the mastectomy site after the treatment of particularly, let us say a locally advanced breast cancer, is often more about the biology of the cancer itself. In another words, if you look at mastectomy series, published literature about mastectomies. When we look at the chance of the cancer coming back to the mastectomy site, it is typically related to the biology of the cancer or more aggressive cancer. There is work being done on circulating tumor cells that may actually repopulate the original mastectomy site. If a cancer is locally advanced originally, then we are talking about the combination of surgery actually chemotherapy first followed by surgery followed by radiation therapy. Even the combination of multimodality treatment is not a guarantee that the cancer could not come back at the mastectomy site, so clearly you need to be monitored for that.
The question then comes over “Dear Dr. Harness, how am I monitored?” Well, physical examination, seeing your doctors regularly, well not a standard of care I often get mammograms even after a mastectomy for the first few years looking for the possibility of the cancer coming back and breast MRI is certainly acceptable in stage III breast cancers looking for a local recurrence.
Now let me switch gears here a little bit and now talk about prophylactic mastectomy or a good example if you have been treated for an in situ breast cancer, can the cancer come back at the mastectomy site? Again, the answer is if you have been treated for an in situ breast cancer, depending on the biology of that in situ breast cancer, the extent of it, the grade of it, a variety of factors indeed the cancer could come back at the mastectomy site, particularly if it has migrated up into the fatty tissue and perhaps missed by the surgeons at the time of the mastectomy, so that is indeed a possibility.
Let me wrap this up and talk about prophylactic mastectomy or as an example where there was lobular carcinoma in situ and a strong family history of breast cancer and the mastectomies are being done in one sense prophylactically. What I tell patients all the time is there is no breast surgeon on the planet, who can guarantee you that 1000% of all breast tissue is removed at the time of a mastectomy whether for treatment or whether done prophylactically.
Breast tissue can be scattered around at the microscopic level, it can extend what are called the Cooper’s ligaments and so, as an example if we knew your gene positive and you have prophylactic mastectomies, all we can tell you is that we will reduce the chance of you getting breast cancer or dying from breast cancer by 95%.
So, what is the take-home message from us, well there is a couple of them, one is depending on the original extent of your cancer, indeed there is a possibility it can locally recur at the mastectomy site. You should be monitored for that by the confident team that you are working with. I have already indicated some of the ways of doing that with physical exam, mammogram, and potentially even MRI, but also be cognisant of your mastectomy sites; do self-examination. Even if you have been done, had your mastectomies done purely prophylactically, knowing that over the entire rest of your life, there is a chance that things could come back, be aware of that; be empowered; and take the necessary action.
Dr. Jay K. Harness is a board certified surgeon currently treating patients at St. Joesph Hospital in Orange, CA. Dr. Harness specializes in complete breast health, breast cancer surgery, oncoplastic reconstruction, genetic screening, management of breast health issues, risk assessment and counseling. Dr. Harness is the medical director for Breast Cancer Answers.com, and guides this first ever social media show’s information by drawing on his former leadership experience as the President of the American Society of Breast Surgeons and Breast Surgery International. Dr. Harness graduated from the University of Michigan, Ann Arbor in 1969 and spent time early on in his career at the University of Michigan Medical Center.
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