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Majority of Women Undergoing Contralateral Prophylactic Mastectomy Have No Major Risk Factors for Developing Cancer in Both Breasts

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Key Points

  • Of the 1,447 women included in the sample, 18.9% strongly considered contralateral prophylactic mastectomy and 7.6% underwent the procedure.
  • The majority (68.9%) of patients who underwent contralateral prophylactic mastectomy had no major genetic or family risk factors.
  • Decision to undergo contralateral prophylactic mastectomy was significantly associated with genetic testing, a strong family history of breast of ovarian cancer, receipt of MRI, higher education, and greater worry about recurrence.

Patients deciding to undergo contralateral prophylactic mastectomy as part of initial treatment for breast cancer is a growing challenge in the management of the disease. Removing the unaffected breast has not been shown to increase survival, and the more aggressive procedure is associated with more complications and a difficult recovery.

The Society of Surgical Oncology suggests contralateral prophylactic mastectomy only be considered for a minority of patients at a higher than average risk of developing cancer in both breasts, especially patients with a genetic mutation or a strong family history with at least two first-degree relatives. However, in a recent study published in JAMA Surgery, Hawley et al found that the majority of patients who chose to undergo contralateral prophylactic mastectomy had no major risk factors for developing cancer in both breasts.

Study Details

Investigators conducted a longitudinal survey of 2,290 women with newly diagnosed breast cancer who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries from June 2005 to February 2007 and again from June 2009 to February 2009.

Of the 1,447 women included in the sample, 18.9% strongly considered contralateral prophylactic mastectomy and 7.6% underwent the procedure. Of those who strongly considered contralateral prophylactic mastectomy, 32.2% had the procedure, 45.8% underwent unilateral mastectomy, and 22.8% received breast conservation surgery to remove the cancer. The majority (68.9%) of patients who underwent contralateral prophylactic mastectomy had no major genetic or family risk factors. Among women who received contralateral prophylactic mastectomy, 80% reported they had the procedure to prevent breast cancer in the unaffected breast, and most women also had breast reconstruction surgery.

Factors Affecting Receipt of Contralateral Prophylactic Mastectomy

Multivariate regression showed that the decision to undergo contralateral prophylactic mastectomy vs unilateral mastectomy or breast-conservation surgery was significantly associated with genetic testing (positive or negative), a strong family history of breast of ovarian cancer, receipt of magnetic resonance imaging, higher education, and greater worry about recurrence.

The investigators concluded, “Many women considered [contralateral prophylactic mastectomy] and a substantial number received it, although few had a clinically significant risk of contralateral breast cancer…. Worry about recurrence appeared to drive decisions for [contralateral prophylactic mastectomy] although the procedure has not been shown to reduce recurrence risk.”

In a related commentary, Shohana M. Rosenberg, ScD, and Ann H. Partridge, MD, MPH, of Dana-Farber Cancer Institute, Boston, noted that the pros and cons of different treatment options should be considered, as well as careful consideration of a patient’s individual personal circumstances and perceptions regarding breast cancer recurrence. “Decision-making surrounding early breast cancer, with respect to [contralateral prophylactic mastectomy] in particular, provides an opportunity to encourage a supportive, shared decision-making approach,” they wrote.

Sarah T. Hawley, PhD, MD, of the University of Michigan Medical School, is the corresponding author for the JAMA Surgery article.

The study was funded by grants to the University of Michigan for the National Institutes of Health. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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