Can double mastectomy be considered in early-stage BC at 26?

Question

Hello doctor,

My younger cousin, who is only 26 years old, recently found out she has early-stage breast cancer. It is such a shock, given her age. The surgeon suggested she should remove just one breast for now, but she is wondering whether she should go for a double mastectomy to lower future risk. She is also asking whether it is worth doing genetic testing because no one else in our family has had cancer before. She has not started treatments yet and already feels drained.

Does that make sense in her case?
Could other underlying issues be causing her tiredness?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am so sorry to hear about your cousin's diagnosis at just 26; it is a huge shock. It is great that she is thinking through her treatment options carefully, and it is normal to have a lot of questions, especially with something as serious as breast cancer.

Single versus double mastectomy: The decision between a single mastectomy and a double mastectomy depends on several factors, such as:
Cancer location and size: If the cancer is only in one breast and there is no indication of its spread, a single mastectomy is often recommended because it is less invasive and preserves the other breast.
Personal risk and family history: Even though no one else in your family has had breast cancer, some women may choose a double mastectomy for peace of mind, especially if they are concerned about future risk or if they have high levels of anxiety about recurrence. This decision is more common in women with a strong family history or those who carry certain genetic mutations, but it is not the right choice for everyone.
Genetic testing: In her case, genetic testing could help clarify her risk of developing cancer in the future. If she tests positive for mutations like BRCA1 or BRCA2 (even without a family history), she may be at higher risk for breast cancer in both breasts and ovarian cancer. If she tests negative, the decision to remove the second breast may be less clear, though some still opt for it to reduce anxiety and risk. Even though no one else in the family has had cancer, genetic testing can still be valuable.

Some people with no family history of cancer carry mutations that increase their risk, and knowing whether they carry a gene like BRCA1, BRCA2, or other related genes could influence their treatment decisions. For instance, it might help decide whether she needs additional treatments (like chemotherapy or hormone therapy) or preventive measures for the future. Given her age, genetic testing could provide valuable information to help her make the most informed decision about her treatment and future health, even if it is not a direct answer to why she got cancer in the first place.

Fatigue: It is completely normal for her to feel drained right now, especially considering the shock of the diagnosis, the stress of potential treatments, and the emotional weight of what she is going through. But sometimes, fatigue can also be linked to other factors, such as:
Hormonal changes: If she has had surgery or a biopsy or started any medication (like hormone blockers or chemotherapy), these can contribute to fatigue.
Anxiety and stress: Dealing with the emotional side of a cancer diagnosis can be exhausting in itself. Anxiety, stress, and lack of sleep often contribute to fatigue.
Nutritional factors: Sometimes, cancer can affect appetite or cause nausea, which can lead to insufficient nutrition, making fatigue worse. If she is not eating well, this can also contribute to feeling drained. If she is feeling this tired even before starting treatments, it could be more of a result of the emotional toll and the shock of the diagnosis rather than something directly related to the cancer itself. However, it is always good for her to talk with her oncologist about this, especially to rule out any other underlying health issues or treatment-related side effects.
Next steps: Consult with an oncologist about the pros and cons of a double mastectomy versus a single mastectomy. Consider getting genetic testing to clarify her future risk. Discuss her fatigue with her doctor to determine whether it is related to her diagnosis or if there could be another cause. Her feelings are completely valid, and it is important to let her know that she is not alone in this process. It might be a good idea for her to lean on support networks, like family, friends, or even counseling, to help manage the emotional weight as she navigates these tough decisions.

I hope this information will help you.