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Prophylactic mastectomy after DCIS?

Page last modified on: October 7, 2008
Question from AWatts: I just had a mastectomy on the left side due to DCIS. I do not want to take tamoxifen. I am considering a mastectomy on the other side because next time around I may not be so lucky. Is this too aggressive?
Answers —Beth DuPree, M.D., F.A.C.S.: Your decision to have a prophylactic mastectomy needs to be based on several factors: a very careful assessment of your family history and true risk, as well as the ability to screen the opposite breast with mammography and clinical exams. It is not unreasonable, particularly for younger women, to feel that their overall lifetime risk of developing an invasive breast cancer and the stress that goes with that might lead them to undertake a mastectomy as an option.

But this decision needs to be weighed very carefully and should be thought out very clearly prior to moving forward with that particular surgery. In my population of patients, those with DCIS tend to choose prophylactic surgery for the opposite breast more often than women with invasive cancers. This is because prophylactic surgery can certainly decrease the risks of an invasive cancer in the opposite breast for women with DCIS. And that removes the need in the future for chemotherapy or radiation therapy. But as we have said before, this is certainly a decision that needs to be discussed very thoroughly with your physician, medical oncologist, and plastic surgeon.
Lynn Hartmann, M.D.: In studies of DCIS that have tracked the likelihood of a cancer in the opposite breast, the number is often lower than someone might expect. In one large trial after about six to seven years of follow-up, approximately 4% of women developed a second breast cancer in the opposite breast. It's important for women to understand the actual risk they have as they make those decisions.

On Wednesday, February 15, 2006, our Ask-the-Expert Online Conference was called Risk Reduction. Lynn C. Hartmann, M.D. and moderator Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about a variety of topics such as screening with mammograms, MRIs, and ultrasounds; breast biopsies; lifestyle changes that make a difference; and making hard decisions about prophylactic surgeries.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Lynn C. Hartmann, M.D.Lynn Hartmann, M.D. is a professor of oncology at the Mayo Clinic and associate director for education of the Mayo Clinic Cancer Center.

Beth Baughman DuPree, M.D., F.A.C.S.Beth Baughman DuPree, M.D., F.A.C.S. is a general surgeon. Her clinical practice is located at Holy Redeemer Hospital and St. Mary Medical Center.

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