Patients and caregivers should weigh the expected benefits with the potential risks of a contralateral (double) prophylactic mastectomy.
A recent Brigham and Women’s (BWH) study reveals that from 2002 to 2012, the number of women choosing to have both of their breasts removed as a strategy to prevent the recurrence of breast cancer – a procedure known as contralateral prophylactic mastectomy (CPM) – tripled in the U.S., but without a corresponding improvement in survival. Researchers note that while CPM may have a survival benefit for patients that are at high risk of developing breast cancer, such as those with a genetic mutation, the majority of women undergoing CPM are at low risk for developing breast cancer in the unaffected breast.
“Our analysis highlights the sustained, sharp rise in popularity of CPM, while contributing to the mounting evidence that this more extensive surgery offers no significant survival benefit to women with a first diagnosis of breast cancer,” says senior author Dr. Mehra Golshan, Distinguished Chair in Surgical Oncology at BWH. “Patients and caregivers should weigh the expected benefits with the potential risks of CPM, including prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and effects on self image.”
Researchers analyzed data from a group of nearly 500,000 women with a unilateral (in one breast) stage-one to stage-three breast cancer diagnosis and followed them over a period of over eight years. Of these patients, 59.6 percent underwent breast-conserving surgery (lumpectomy), 33.4 percent underwent unilateral mastectomy, and seven percent underwent CPM. The researchers found that even when compared with breast-conserving therapy, which involves removing only the tumor and a small amount of surrounding tissue, no significant improvement in survival was found for women undergoing CPM.
Along with an abundance of caution, surveys of women suggest that a desire to minimize breast asymmetry and improve overall appearance through increasingly available and expanding reconstructive techniques also may influence a decision to undergo CPM. Specifically, researchers show that rates of reconstruction in CPM patients increased from 35.3 per cent to 55.4 per cent during the study period.
“Women with unilateral breast cancer undergoing CPM continue to report a desire to extend life as one of the most important factors leading to their surgical decision,” says Dr. Golshan. “Understanding why women choose to undergo CPM may create an opportunity for health care providers to optimally counsel women about surgical options, address anxieties, discuss individual preferences, and ensure peace of mind related to a patient’s surgical choice.”
– Elaine S., Chris P.