Guidelines for Offering Preventive Mastectomy to High-Risk Women

Recent research conducted by experts from Queen Mary University of London, the London School of Hygiene and Tropical Medicine, Manchester University, and Peking University suggests that more women at an elevated risk of developing breast cancer should consider preventive mastectomy. Traditionally, this surgical intervention is reserved for women carrying high-penetrance genetic mutations like BRCA1, BRCA2, and PALB2. However, the new analysis indicates that expanding criteria based on individual risk assessments could significantly reduce breast cancer incidence.

The study, published in JAMA Oncology, utilized a sophisticated economic evaluation model aligned with NHS guidelines to determine when mastectomy becomes a cost-effective strategy. The findings reveal that women over age 30 with a lifetime breast cancer risk of 35% or higher could substantially benefit from RRM, potentially preventing approximately 6,500 cases annually in the UK.

Personalized risk prediction models, factoring in genetic and other health data, currently guide treatment decisions such as mammograms, MRI screenings, medication, or surgery. But this research advocates for a broader application of risk-reducing surgery beyond women with known genetic mutations. The key is identifying individuals with a sufficiently high predicted risk where surgery offers not only health benefits but also economic value.

Using a cost-effectiveness threshold of £30,000 per quality-adjusted life year (QALY), the study highlights that mastectomy becomes a prioritized prevention method for women aged 30 to 55 with a lifetime risk of 35% or more. Implementing such measures could lead to a meaningful reduction in breast cancer cases and improve health outcomes.

Professor Ranjit Manchanda emphasized that this work defines specific risk levels at which mastectomy should be recommended and calls for further research on patient acceptability and long-term outcomes. Dr. Rosa Legood added that, for women within this risk group, RRM is a viable, economic preventive option. Funding from organizations like Rosetrees Trust supports this groundbreaking effort to personalize breast cancer prevention strategies.

Overall, the study suggests that expanding surgical prevention frameworks based on individual risk could have a significant impact on breast cancer prevention, saving lives and optimizing healthcare resources.

Source: https://medicalxpress.com/news/2025-07-mastectomy-women-higher-breast-cancer.html