Revised guidelines highly recommend that women with hereditary breast cancer remove their healthy breast to reduce the risk of death, but such patients would also face tough choices concerning their mental state and finances.

The Japanese Breast Cancer Society on May 16, in its first revised guidelines in three years, also advised women with mutated genes that raise the risk of cancer to remove both of their healthy breasts as a preventative measure.

The society said such operations should be done only if the patients expresses their willingness and a sufficient counseling system is set up at medical facilities.

However, public health insurance does not cover genetic screening for hereditary cancer gene mutations or the preventive surgery itself. For treatments that could save their lives, the patients would have to pay with their own money.

“Social discussions (on preventive mastectomies) related to ethics and costs are essential, in addition to improving counseling systems at each hospital,” said Masahiko Ikeda, the head of the department for breast and thyroid surgery at Fukuyama City Hospital in Fukuyama, Hiroshima Prefecture. “I want people who need such surgeries to fully consult with their doctors to decide whether to undertake the operation.”

Blood tests can identify mutations in the BRCA1 or BRCA2 genes. Forty percent to 90 percent of women with such genetic mutations develop breast cancer in their lifetimes.

That is six to 12 times the probability among women whose genes are not mutated, according to medical studies.

Breast cancer is the most common form of cancer among women in Japan, with an estimated 80,000 people newly diagnosed annually. Among them, 5 percent to 10 percent have hereditary breast cancer.

Although studies in recent years confirmed that preventive surgery reduces the risk of developing breast cancer and the fatality rate, some experts said they cannot recommend a surgery that is not covered by public health insurance.

The society’s previous treatment guidelines said such preventive surgery “can be considered.”

But doctors at the society concluded that they should recommend the operation to remove the healthy breast because medical evidence proves that it lowers the risk of breast cancer and the fatality rate.

The issue of preventative double mastectomies made headlines after Hollywood star Angelina Jolie in 2013 disclosed that she had undergone the procedure. She did not have cancer but decided to have her breasts removed after learning that genetic mutations put her at high risk of developing cancer.

The society issued a “moderate recommendation” for preventive double mastectomies because the fatality rate of individuals who had undergone such surgeries has been declining and the operation has reduced the risk of developing breast cancer.

In addition, some reports say the surgery helps relieve anxiety in patients.