Understanding Why Preventive Mastectomy Isn't Accessible to All at-Risk Individuals

Preventive mastectomy, the surgical removal of breast tissue to reduce cancer risk, has gained public attention through high-profile cases such as celebrities Christina Applegate and Angelina Jolie. While this procedure can be life-saving for those with high genetic risk, it remains unevenly available across populations. Typically, mastectomy is recommended after a breast cancer diagnosis or when genetic testing reveals significant inherited mutations, such as in the BRCA1 and BRCA2 genes. These mutations are associated with a lifetime breast cancer risk exceeding 60%, prompting preventive options like surgery.

The decision to undergo a preventive mastectomy is deeply rooted in genetics. Mutations in tumor suppressor genes like BRCA can compromise the body's ability to regulate cell growth, leading to unchecked proliferation and cancer development. The public awareness surrounding BRCA mutations surged after Angelina Jolie's candidness about her preventive surgeries following her genetic testing and family history. This openness has significantly increased testing and preventive surgeries among women at high genetic risk.

However, the focus on BRCA mutations has created a narrow view, overshadowing other genetic factors that also influence breast cancer risk. Research shows that mutations in other moderate-risk genes can raise the likelihood of developing breast cancer two to four times higher than normal. Despite this knowledge, preventive mastectomy is rarely offered to carriers of these less-studied mutations. Several barriers contribute to this gap—insufficient scientific evidence to support the procedure's effectiveness for moderate-risk mutations, limited clinical guidelines, and economic constraints.

Implementing broader access to preventive mastectomy could potentially prevent more breast cancer cases. Some studies suggest that expanding the procedure beyond BRCA mutation carriers might avert up to 11% of future cases, leading to significant human and economic benefits. Yet, expanding surgical options raises concerns about additional strain on healthcare systems, costs, and the need for more evidence.

This disparity highlights a profound inequality in cancer prevention efforts. Users with well-known high-risk mutations benefit from decades of research and tailored clinical guidelines, whereas those with other genetic profiles are often left with surveillance and uncertainty. As genetic testing becomes more affordable and widespread, the gap in preventive options risks widening unless updated research and guidelines are developed.

Ultimately, true personalized medicine in cancer prevention must ensure equitable access to a full range of options for all at-risk individuals, regardless of their genetic makeup. Until such measures are in place, access to preventive mastectomy will continue to be influenced by chance and the specific genetic mutations one carries.