Some underlying conditions or congenital or genetic traits are associated with a significantly higher incidence of cancer. When these cancers are likely to occur in non-essential organs, the potentially involved organ may be removed or the anatomical, developmental or genetic defect corrected to prevent or reduce risk of subsequent malignancy.1, 2
Examples of prophylactic surgical approaches include:1, 2
- surgical correction of cryptorchidism or undescended testis which is associated with a 10- to 40-fold increase in the incidence of testicular cancer
- prophylactic colectomy for individuals susceptible to hereditary non-polyposis colorectal cancer (HNPCC)
- prophylactic bilateral or contralateral mastectomy and oophorectomy for individuals with breast cancer who carry a BRCA1 or 2 gene mutation.
There are many psychological and ethical considerations related to prophylactic surgery and regular invasive surveillance. An at-risk individual's response depends on the real or perceived sense of threat they feel as a result of their cancer risk, personality traits and the psychological morbidity associated with a strong family history of cancer. Regular medical surveillance and counselling may help. SCNs need to consider the needs of the individual's whole family as anxiety, uncertainty and an irrational fear of cancer may persist irrespective of the test result.2
Access the following resources and complete the following :
Targeted tailored management of the breast cancer patient at risk for harboring a germline mutation - current trends affecting the selection of patients considering surgical prophylaxis for breast cancer3 (free resource, but you must register and login to access it)
Decision making regarding prophylactic mastectomy: stability of preferences and the impact of anticipated feelings of regret4
Positive, negative, and disparate - women's differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy5
Support needs and acceptability of psychological and peer consultation: attitudes of 108 women who had undergone or were considering prophylactic mastectomy(PDF, 182KB)6
- Summarise the indications for prophylactic bilateral or contralateral mastectomy
- Outline the issues identified in the readings which affect a woman's decision making process when considering prophylactic mastectomy
- Describe the role of the SCN in meeting the needs of women:
- Considering prophylactic mastectomy
- Following prophylactic mastectomy.
Jeff is a 38 year old man who has had treatment for hereditary non-polyposis colon cancer (HNPCC). His sister, aged 35, has the same gene mutation. Their father and paternal grandmother both died in their 40s from colon cancer. Discuss the evidence which may inform:
- The advice and support an SCN may provide to this family about their cancer risk
- The role and implications of regular surveillance and prophylactic surgery.
The following resources may be helpful: