Prophylaktische Mastektomie bei Frauen mit hohem Brustkrebsrisiko: Indikationen und Alternativen

Zusammenfassung

Die bilaterale prophylaktische Mastektomie erzielt bei Hoch-Risiko-Frauen für ein Mammakarzinom eine Risikoreduktion um bis zu 95 Prozent. Bei strenger Indikationsstellung und dem Willen der informierten Patientin kann die prophylaktische Mastektomie ab dem 25. Lebensjahr durchgeführt werden. Alternativ kann bei BRCA1/2-Mutationsträgerinnen mit hereditärem Mamma- und Ovarialkarzinom die bilaterale prophylaktische Ovarektomie und Salpingektomie das Brustkrebsrisiko um 50 Prozent und das Eierstockkrebsrisiko um 90 Prozent senken. Für Frauen ab dem 35. Lebensjahr ohne Kinderwunsch wird diese Form der chirurgischen Prophylaxe derzeit häufig empfohlen. Für die Chemoprävention ist die Datenlage bei prämenopausalen Hoch-Risiko-Frauen bislang nicht gesichert, sodass diese Maßnahme derzeit nur im Rahmen von klinischen Studien empfohlen wird. Gegenüber radikaleren ablativen Verfahren favorisieren wir die subkutane Mastektomie als prophylaktische Maßnahme bei Hoch-Risiko-Frauen für ein Mammakarzinom, da diese bei technisch korrekter Durchführung eine hohe onkologische Sicherheit mit guten ästhetischen Ergebnissen verbindet, insbesondere in Kombination mit mikrochirurgischen autologen Rekonstruktionsverfahren. Beide Aspekte sind für die häufig jungen und noch gesunden Frauen mit dieser Indikation von elementarer Bedeutung bei der Entscheidungsfindung für oder gegen eine prophylaktische Mastektomie.

Abstract

In women at high-risk for breast cancer, bilateral prophylactic mastectomy achieves a risk reduction of up to 95 percent. Provided that proper indications are adhered to and informed consent has been obtained, prophylactic mastectomy can be performed starting at the age of 25 years. As an option, in BRCA1/2 mutation carriers with hereditary breast and ovarian cancer, bilateral prophylactic ovarectomy and salpingectomy reduce the risk of breast cancer by 50 percent and the risk of ovarian cancer by 90 percent. In women of at least 35 years of age and without wish for child bearing, this means of surgical prevention is often suggested at present. The database on chemoprevention in premenopausal high-risk women remains to be defined and procedures are currently advised in conjunction with clinical trials only. As opposed to more radical ablative techniques, we favour subcutaneous mastectomy as a prophylactic means in women at high risk for breast cancer. It combines oncological safety and excellent aesthetic results if performed with the correct surgical technique. Both aspects are of fundamental importance to the often young and still healthy women with this indication who are confronted with the difficult decision for or against a prophylactic mastectomy.

Schlüsselwörter

BRCA - familiäre Häufung - hereditär - Mammakarzinom - subkutane Mastektomie - prophylaktisch

Key words

BRCA - familiar accumulation - hereditary - breast cancer - subcutaneous mastectomy - prophylactic

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