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Contralateral Prophylactic Mastectomy

Breast Surgery: How to Guide Patients Through Their Choices of Procedure

Contralateral prophylactic mastectomy (CPM) has risen by 30% over the last 10 years in the United States, but CPM may not be the best surgical option for most patients. While CPM seems like the best option to reduce likelihood of cancer recurrence and risk of contralateral breast cancer, few women have a medical condition that necessitates removal of the contralateral breast.

The indications for CPM are pathogenic genetic mutation (eg, BRCA1 and BRCA2), a strong family history of breast cancer, or prior mediastina chest radiation. For women with no family history of breast cancer, no genetic mutation, and no prior chest wall radiation, the risk of developing a new breast cancer in their other breast is only 3% to 5% every 10 years.

Contrary to what patients may believe, CPM does not prevent the development of metastatic disease and offers no survival benefit over breast conservation or unilateral mastectomy. In fact, compared with unilateral therapeutic mastectomy, CPM carries a 2.7-fold risk of a major surgical complication. Removing the healthy breast can double the risk of postsurgical complications, including bleeding, infection, and loss of tissue and implant.

Current recommendations emphasize of a multidisciplinary team approach to review a patient’s case and discuss the ideal treatment plan before surgery. This approach should have emphasis on minimally invasive biopsy and better cosmetic outcomes to enhance the quality of care.  Some breast cancer subtypes respond particularly well to chemotherapy with new types of chemotherapy allowing up to 60% of some breast cancers to diminish almost completely. How long a patient lives from the time of breast cancer diagnosis depends on the stage of the cancer at diagnosis, not the type of surgery performed.

Key factors to discuss with patients include: cancer stage at diagnosis, family history and genetic risk, and cancer risk versus surgical risk. Unless a woman has a strong family history of breast cancer, is diagnosed at a very young age, or has a genetic cancer-causing mutation, removing the contralateral healthy breast is not medically necessary and is not routinely recommended.

 

Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: December 14, 2016

Source: OBG Management
Adapted from the original article.

[Image: Pixabay / KlausHausmann]