Prophylactic Mastectomy in Breast Cancer Patients

One of the dilemmas facing oncologists is what to do when a patient with breast cancer asks "should I get the other breast removed?".

One of the dilemmas facing oncologists is what to do when a patient with breast cancer asks "should I get the other breast removed?". It seems like it should be a simple "yes" or "no"- one has already experienced the trauma of one breast cancer diagnosis and wishes to prevent another experience so asks if it is reasonable to take both breasts.

However, taking off the unaffected breast does not remove the risks facing a patient who has breast cancer. There is still the already diagnosed one that will need treatment, surveillance after treatment, and will confront him or her with risks for relapse in the future. Taking off an unaffected breast will not change that. Is this true?

A new study from MD Anderson used data from the Surveillance, Epidemiologic, and End Results (SEER) Data set to answer this. Bedrosian, et al. analyzed data from 107,106 women with breast cancer, treated between 1998 and 2003. Removal of the unaffected breast [contralateral prophylactic mastectomy, or CPM] was done on almost 9,000 of these women. In their analysis, CPM was associated with a 27% reduction in the risk of death in women with breast cancer. However, this effect was limited only to women with early breast cancer (Node-negative, Stage I or II) and whose tumors were estrogen receptor negative. Even within this group, there was only a 5% improvement in 5-year survival seen- a modest benefit to be sure.

What the analysis does not address is the issues in survivorship: what was the effect of CPM on sexual health, psychological functioning, and overall quality of life? Were their any indicates of regret in these women?

Still, these results can help in how I counsel patients who are contemplating CPM and I welcome these results which help to answer a significant clinical dilemma.

For more information: Bedrosian I, Hu CY, Chang GJ. Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients. Journal of the National Cancer Institute 2010; Feb 25 [Epub].