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Because of the very high risk for a second (or third) breast cancer diagnosis, some women who are diagnosed with hereditary breast cancer choose bilateral mastectomy (surgical removal of both breasts) rather than undergoing lumpectomy and radiation. Studies have shown similar survival rates for women with BRCA mutations who undergo lumpectomy and radiation and women who undergo mastectomy. However, mutation carriers who undergo mastectomy are less likely to develop a second breast cancer
BRCA carriers are at increased risk for ovarian cancer. In women with estrogen receptor-positive breast cancer, treatment sometimes involves injections to shut down the ovaries' production of estrogen. For BRCA mutation carriers who are at increased risk for ovarian cancer, another option may be oophorectomy, which removes the ovaries to lower the risk for ovarian cancer. Further, oophorectomy has also been shown to lower the risk for primary breast cancers in BRCA carriers who do not have bilateral mastectomies.
Women who carry a BRCA mutation are recommended to have "risk-reducing salpingo-oophorectomy" also known as RRSO (removal of the ovaries and fallopian tubes" between age 35-40 and after child-bearing is complete. There are no guidelines regarding hysterectomy (removal of the uterus) at the time of RRSO. Tamoxifen - a medication used to treat some breast cancers - can increase the risk for uterine cancer. Women with mutations who must take tamoxifen may choose to have a hysterectomy at the time of their RRSO.