Mastectomy recommended for triple-negative?


Question from Judy: Do you recommend mastectomy for triple-negative?
Answers - Beth Baughman DuPree, M.D., F.A.C.S. The decision to perform a mastectomy or lumpectomy is not based upon the tumor being triple-negative or being estrogen-receptor positive or progesterone-receptor positive or HER2/neu positive. Lumpectomy followed by radiation therapy and mastectomy are equal treatment options for the local treatment of breast cancer. The determination for whether or not radiation therapy would be required after mastectomy would be determined by whether or not more than three lymph nodes were involved with tumor, or whether the tumor had spread beyond the capsule of the lymph node. Removing a woman's breast does not guarantee that a tumor will not recur elsewhere in the body. I always begin my breast cancer consults with my patients by stating to them that no woman ever died of breast cancer in her breast; women die of breast cancer as a result of cancer cells spreading outside the breast and lodging in other organs. Because of this fact, mastectomy would be the option for the treatment of breast cancer for several reasons. If a breast cancer is what we call locally advanced or inflammatory, where the actual skin of the breast shows signs of edema or actually has cancer cells within the dermis of the breast, then chemotherapy would be given in what we call neoadjuvant or prior to surgery, and regardless of the clinical response of that breast, the mastectomy and radiation therapy would be indicated. If a tumor is identified in the breast that is so large that the cosmetic defect of the breast would be great, mastectomy would also be an option, but neoadjuvant chemotherapy to shrink the tumor would also be an option to preserve the breast. Just because a tumor is triple-negative does not mean a mastectomy is mandatory.
George Sledge, M.D. Would you feel differently in a young woman with a breast cancer who was BRCA1 positive?
Beth Baughman DuPree, M.D., F.A.C.S. In a patient that is BRCA1 positive, I would discuss what the risk of a contralateral breast cancer would be in her lifetime. Because this risk by the age of 87 can be as high as 70%, in those patients bilateral mastectomy with reconstruction would be a very good option. I do not believe that a mastectomy in a BRCA1 patient is mandatory, but it's important for them to understand what their risk is. Because many of the triple-negative tumors can develop quickly, many of these patients will opt for the surgical treatment of breast removal and reconstruction to be able to move forward with their life and feel they have done everything they can surgically to reduce the change of a cancer developing in the opposite breast. The cosmetic results after current reconstruction procedures are excellent, and therefore bilateral mastectomy is not the disfiguring operation that it was 20 years ago. I always explain to my patients who choose this operation that their risk will never go to zero, as there is approximately a 2% risk of a primary breast cancer occurring in the skin flap, since not every single cell can be removed at the time of surgery.

On Wednesday, July 16, 2008 our Ask-the-Expert Online Conference was called Triple-Negative Breast CancerGeorge Sledge, M.D. and Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about triple-negative breast cancer and its treatment.

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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