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May 14, 1997

Study Shows Mastectomy Prevents Breast Cancer in High-Risk Women

JAMA. 1997;277(18):1421-1422. doi:10.1001/jama.1997.03540420015004

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ONE OF THE mixed blessings of the discovery of genes in some women that markedly raise the risk for developing breast cancer and the availability of genetic testing has been the question of how this knowledge can be useful to such high-risk women.

Increased surveillance is advised to detect and treat cancers as early as possible, but the issue of a preemptive strike — prophylactic mastectomy—has been more troubling. The problem is that there have been no solid data to back up the assumption that the radical step of removing healthy breasts would actually prevent the onset of disease, because the procedure is likely to leave some residual bits of breast tissue behind.

Because of this, and the lack of data addressing the issue, many experts have maintained that the procedure must be considered unproved and women in highrisk families have to be advised of the uncertainty regarding its effectiveness—a