There has been a lot of discussion lately in the media about having a double mastectomy to prevent breast cancer with Angelina Jolie recently going through the procedure.

In hopes of avoiding future disease, some women at very high risk of developing breast cancer elect to have both breasts surgically removed, a procedure called bilateral prophylactic mastectomy or preventative mastectomy. The surgery aims to remove all breast tissue that potentially could develop breast cancer.

Who may consider prophylactic mastectomy to reduce breast cancer risk?

All women are at risk of breast cancer just by being female and advancing age. But some factors increase your risk significantly. You may consider prophylactic mastectomy if you have:

Already had cancer in one breast. If you develop breast cancer and have a strong family history of the disease, you may decide to have both breasts removed. One breast is removed to get rid of the cancer, and the other, unaffected breast is removed to greatly reduce the possibility of developing another breast cancer in the future.

A family history of breast cancer. If you have a mother, sister or daughter with breast cancer, especially if she was diagnosed before age 50, you may be at an increased risk of developing breast cancer. If you have multiple family members with breast cancer or ovarian cancer, your risk of breast cancer may be greater. A predisposition to breast cancer can be passed on to you through your mother’s or father’s side of the family.

Positive results from gene testing. Genetic testing can identify if you have mutations in genes that increase your risk of breast cancer or other cancers such as ovarian cancer. Genes known to increase the risk of breast and ovarian cancers include BRCA1 and BRCA2. If you have a strong family history of breast cancer, you may consider meeting with a genetic counselor to discuss genetic testing.

Breast changes that increase your risk of breast cancer. Your doctor may have discovered abnormal cells in the milk-producing glands (lobules) of your breast (lobular carcinoma in situ). This finding is not cancer, but is a marker of an increased risk of developing breast cancer in both breasts.

Radiation therapy. If you had radiation therapy to your chest before age 30, you have an increased risk of developing breast cancer.

Dense breasts. Dense breast tissue is associated with breast cancer, and it makes it harder for doctors to diagnose breast cancer. In certain cases, a woman with dense breasts may consider a prophylactic mastectomy, especially if she has other risk factors, such as a strong family history of breast cancer or precancerous conditions.

Your doctor determines whether you’re at a high risk of breast cancer based on your risk factors and on mathematical models that calculate your lifetime risk of breast cancer.

Deciding what to do with the knowledge that you are at high risk of breast cancer is a complex and time-consuming process. It’s best if you can work with a team of health professionals to get a complete evaluation of your risk and all of your options. Making the decision whether to have a double mastectomy is not urgent. Give yourself time to weigh all the pros and cons. You may want to discuss your concerns and feelings with a breast-health specialist and psychologist.

A double mastectomy reduces the risk of developing breast cancer by 90 percent in high-risk women. Having a prophylactic mastectomy doesn’t guarantee that you’ll never develop breast cancer because all of you breast tissue can’t be removed during surgery. Sometimes breast tissue can be found in your armpit, above your collarbone or on the upper part of your abdominal wall, where it may not be detected at the time of surgery. Breast tissue remaining in your body can still develop breast cancer, although the chances are slim.

Having a double mastectomy is definitely something that requires a lot of research and thought – and a brave woman to make such a difficult decision.

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