What are the alternatives to risk-reducing mastectomy?

Enhanced surveillance aims to find breast cancer early through a personalised schedule of clinical reviews and imaging. A breast MRI may be added to mammography or other imaging when inherited risk, breast tissue or previous findings make closer assessment useful. Risk-reducing medicines can lower the chance of some hormone-sensitive breast cancers, but they have their own effects and are not suitable for everyone. Genetic counselling helps explain what a BRCA gene mutation or another inherited result means for you and relatives. Choosing surveillance does not remove risk; it creates a plan for regular assessment and prompt review of changes.

Start with confirmation of your personal and family history, including the ages and types of cancers in close relatives. Ask whether BRCA genetic testing is appropriate and how a result would change screening or prevention. Discuss pregnancy plans, medicines, breast density, previous biopsies and how comfortable you feel with repeated imaging. A breast specialist can compare the possible benefits, limitations, body changes and follow-up demands of each path. You can ask for time to decide unless your team has identified a finding needing immediate assessment.

Arrange prompt clinical assessment for a new breast lump, nipple inversion, bloody or spontaneous nipple discharge, skin dimpling, persistent one-sided breast change, or swelling in the armpit. These signs can have causes other than cancer, but they should not wait for a routine surveillance appointment. Seek urgent care for rapidly worsening redness with fever or severe breast pain.

What is my estimated inherited and personal risk? Which surveillance schedule fits me? Would medicines be appropriate, and what effects should I watch for? Should my relatives consider genetic counselling? What change should I report between scans?