Mastectomia preventiva: ainda uma estratégia controversa?

  • Fátima Vaz Serviço de Oncologia Médica e Clinica de Risco Familiar, IPOLFG,EPE, Lisboa, Portugal

Resumo

O seguimento de portadoras de mutações nos genes BRCA1/2 e a tomada de decisões sobre as suas estratégias de gestão de risco, desafiam a relação médico-doente clássicamente estabelecida. Neste contexto, há quem advogue o aconselhamento não directivo, com discussão das várias alternativas de redução de risco de cancro, nomeadamente do cancro da mama. A evidência cientifica nesta area é complexa de analizar pois há falta de estudos randomizados e os critérios de selecção são complexos. Os médicos responsáveis pelo seguimento destas doentes devem estar actualizados de forma a possibilitar uma discussão informada e orientá-las na decisão que melhor se adequa aos seus factores individuais. A prevenção cirurgica (mastectomia preventiva e/ou ooforectomia preventiva) reduz de forma significativa o risco de cancro da mama invasivo em mulheres portadoras de mutações nos genes BRCA1 and BRCA2. A mastectomia preventiva é, neste contexto, a estratégia mais eficaz na redução da incidência de cancro da mama. Apesar da sua eficácia, é um procedimento controverso, principalmente porque é considerado não terapêutico e a decisão da sua realização poder ser tomada apenas baseada em critérios clínicos. Com a generalização do rastreio BRCA1 e BRCA2 é possivel fazer uma selecção mais correcta das candidatas para mastectomia preventiva. A aceitação desta técnica cirurgica pelas mulheres em risco e pelos profissionais de saude é variável. A integração da gestão do risco hereditário de cancro da mama em unidades multidisciplinares é sugerida.

Palavras chave: cancro da mama, BRCA1, BRCA2, mastectomia profilactica. 

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Como Citar
VAZ, Fátima. Mastectomia preventiva: ainda uma estratégia controversa?. Revista Portuguesa de Cirurgia, [S.l.], n. 27, p. 99-105, jan. 2014. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/329>. Acesso em: 22 nov. 2019.
Secção
Caderno Especial