This case involves a 56-year-old female patient with a family history of breast cancer. The patient was BRCA negative and underwent a biopsy and subsequent lumpectomy of a tumor. The pathology revealed ADH with no sign of malignancy. The general surgeon recommended that the patient undergo a double mastectomy and counseled her that she was high risk for breast cancer. The patient underwent the surgery and had a very difficult recovery. She had 4 failed breast reconstruction surgeries.
Question(s) For Expert Witness
- 1. How frequently do you treat patients like the one described in this case?
- 2. Generally, what qualifies a patient as a candidate for prophylactic mastectomy?
Expert Witness Response E-131421
I frequently encounter patients like the one described. I am 100% breast in my practice and I help manage our high-risk clinic. Typically patients are considered candidates for prophylactic mastectomy if they carry a genetic trait that significantly raises their risk of breast cancer. If they do not carry a genetic trait, then most experts feel that the risk of breast cancer development should be 30-35% or higher. However, there are individuals who do not meet these criteria that have significant family history and have a significant cancer phobia. These individuals must be educated to understand their risk of developing breast cancer and may still qualify if they understand and have undergone appropriate counseling (including psychological). I have lectured and published in the field of breast disease and cancer. I have also served as an expert witness in the past.