Some women who've been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed. Removing the other healthy breast is called contralateral prophylactic mastectomy.
The healthy breast typically is removed because of understandable fear that a new, second breast cancer might develop in that breast. Some doctors are concerned that too many women are choosing the very aggressive step of contralateral prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer.
The very small study reviewed here found that women considering contralateral prophylactic mastectomy overestimated their risk of developing breast cancer in the healthy breast. Once the women took time to carefully consider their actual risk of developing a new breast cancer, they usually decided against removing the healthy breast. These results were presented at the 2010 European Breast Cancer Symposium.
The study involved 27 women diagnosed with early-stage breast cancer who wanted to have the healthy breast removed at the same time or shortly after breast cancer surgery. All the women believed their risk of developing a new, second breast cancer in the healthy breast was very high. Also, none of the women thought they would be alive 5 years after diagnosis.
All the women agreed to wait 1 year to make their decision about contralateral prophylactic mastectomy. During the 1-year waiting period, the women were given detailed information on their individual risk of developing a new cancer in the healthy breast. After the waiting period, only four women decided to have contralateral prophylactic mastectomy.
When you're first diagnosed with breast cancer, fears about the future can affect how you make decisions. It's understandable that many women would want to eliminate any risk of another breast cancer developing in the healthy breast by choosing contralateral prophylactic mastectomy. Still, the actual risk of a new breast cancer developing in the healthy breast is likely to be much lower than many women estimate. Especially if they're making risk estimates when breast cancer is first diagnosed and treated.
A 2009 study on contralateral prophylactic mastectomy found that that a small group of women with a specific breast cancer risk profile or who had been diagnosed with breast cancer with certain characteristics got the most benefits from prophylactic mastectomy. The women who got the most benefits had any of three factors:
Women with any one of these three factors were more than 3 times more likely than women who did not have any of these factors to develop breast cancer in the opposite breast. Prophylactic mastectomy may make the most sense for women with any one of these three factors.
Based on the study reviewed here, most women considering contralateral prophylactic mastectomy might want to wait to make a final decision. With their doctors, they can learn more about their unique situations and their actual risk of developing a new cancer in the opposite breast and explore all of their options to reduce that risk.
If you've been diagnosed with early-stage breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Contralateral prophylactic mastectomy is only one of these options and is a very aggressive step. While that may be the right decision for you, give yourself the time you need to consider your decision carefully. Talk to your doctor to make sure that your decisions are based on your actual risk. Talk about your Gail score and how the cancer details in your pathology report may affect your future risk. Together, you and your doctor can make the decisions that are best for you and your unique situation.
The National Cancer Institute's Gail score page has more information about the tool.
BARCELONA (MedPage Today) -- Breast cancer patients who request contralateral prophylactic mastectomy greatly overestimate their risk and usually reverse the decision if they take time to "cool off" from the shock of a breast cancer diagnosis, data from a small clinical series suggest.
Only four of 27 women who initially wanted contralateral prophylactic mastectomy went through with the procedure. The others decided against it after taking a year to consider the decision and the facts surrounding it, Ajay Sahu, MD, reported here at the European Breast Cancer Conference.
The initial decision was driven primarily by the patients' belief that their risk of contralateral breast cancer was as much as 10 times greater than it actually was. No patient thought she would survive five years.
"The time of diagnosis isn't the appropriate time for planning prophylactic surgery," said Sahu, of Frenchay Hospital in Bristol, England. "Patients should be counseled about the actual risk, the alternatives should be explained, and they should be given time to reconsider."
Encouraging breast cancer patients to take time to cool off can help avoid many unnecessary mastectomies and the associated morbidity, he added.
Sahu became interested in patient-requested contralateral mastectomy when he noticed an increase in the number of patients wanting the procedure. He reported findings from a study of 27 consecutive patients with newly diagnosed unilateral breast cancer who were requesting contralateral mastectomy. Their ages ranged from 31 to 65.
Patients gave a variety of reasons when asked why they wanted a contralateral mastectomy:
All the patients overestimated their risk of contralateral breast cancer by five- to 10-fold, said Sahu.
In each case, the patient was given information about contralateral breast cancer, counseled about alternatives to surgery, and given the option of delaying the decision about contralateral mastectomy for a year.
When given a chance to consider the facts and options, 23 of the 27 decided not to have contralateral mastectomies.
All the patients expressed less anxiety about their risk of contralateral mastectomy, but four patients still opted for the procedure, three because of family history and one because of lobular cancer.
No studies have ever shown that small, unifocal breast tumors are associated with an increased risk of contralateral breast cancer, said Sahu. Nonetheless, more breast cancer patients are requesting the procedures, and physicians might be complying without addressing the possibility that the patient has an inaccurate perception of risk.
"The incidence of contralateral prophylactic mastectomy has almost doubled in recent times without any evidence of a survival benefit," said Sahu. "The reasons for this need to be addressed, and alternative strategies should be considered."
Sahu reported no disclosures.
Primary source: European Breast Cancer Conference Source reference: Chaudhry A, Sahu A "Patient request for contralateral prophylactic mastectomy is due to a false perception of increased risk at time of initial diagnosis" EBCC 2010; Abstract 233.
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