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Cancer Characteristics Help Doctors Figure Out Who Benefits Most From Removing Other Healthy Breast

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Some women who have been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed. Usually, the healthy breast is removed because of understandable fears that a new, second breast cancer might develop in the other breast. This procedure is called prophylactic mastectomy.

A study found that looking at a woman's breast cancer risk profile and the "personality" of the breast cancer can help doctors figure out which women would benefit the most from prophylactic mastectomy.

Women who've been diagnosed and treated for early-stage breast cancer in one breast have a higher-than-average risk of developing a new, second cancer in the other breast. This risk is very high for some women and only somewhat higher-than-average for other women. If risk is very high, doctors may recommend prophylactic mastectomy. Even without a doctor's recommendation, some women choose prophylactic mastectomy because they understandably fear another breast cancer. Some women request prophylactic mastectomy to have more balanced cosmetic results after reconstructive surgery on both breasts.

Researchers looked at the medical histories of more than 500 women diagnosed with early-stage breast cancer who had prophylactic mastectomy and compared them to the medical histories of more than 1,500 women also diagnosed with early-stage breast cancer who chose not to have prophylactic mastectomy.

The analysis was complex because many factors varied from woman to woman:

  • Some women got chemotherapy and others did not.
  • Some women had the original breast cancer come back (recurrence).
  • Some of the women who had prophylactic mastectomy were diagnosed with very early-stage breast cancer in the breast that was thought to be healthy after it was examined by a pathologist.

These variations made it harder to figure out which women would benefit the most from prophylactic mastectomy.

Still, the results showed that a small group of women with a specific breast cancer risk profile diagnosed with breast cancer with certain characteristics got the most benefits from prophylactic mastectomy:

  • A Breast Cancer Risk Assessment Tool score (also called a Gail score) of more than 1.67% risk. The Gail score is based on a series of specific personal health questions that women and their doctors answer together. The score estimates the risk of a woman developing invasive breast cancer in the next 5 years.
  • A pathology report that showed invasive lobular breast cancer (ILC), which is less common than invasive ductal breast cancer (IDC).
  • Breast cancer in more than one location in the breast.

Women with any of these three factors were more than three times more likely than women who did not have any of these factors to develop breast cancer in the opposite breast. So the researchers concluded that prophylactic mastectomy makes the most sense for women with any one of these three factors.

If you've been diagnosed with early-stage breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Prophylactic mastectomy is only one of these options and is a very aggressive step. While that may be the right decision for you, talk to your doctor to make sure that your decisions are based on your real risk, not only fear. 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.

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