More patients with invasive breast cancer opting for double mastectomies
Full article: https://journals.lww.com/annalsofsurgery/pages/articleviewer.aspx?year=9000&issue=00000&article=96963&type=abstract
Women diagnosed with invasive breast cancer have a number of surgical options. They can have breast-conserving surgery (lumpectomy) with radiation, a unilateral (single) mastectomy to remove only the tissue from the cancerous breast, or a contralateral prophylactic mastectomy (CPM), which removes both breasts. A new study finds that more women are opting for CPM, yet overall survival for these patients is not increasing. (5/3/2016)
The American Society of Breast Surgeons (ASBrS) develops practice guidelines for breast surgery.
ASBRrS recommendations for contralateral prophylactic mastectomy (CPM):
ASBrS convened a panel of experts to develop guidelines on contralateral mastectomy. The ASBrS recommended the following:
CPM should be considered for those at significant risk of CBC
- Documented BRCA1/2 carrier.
- Strong family history, but patient has not undergone genetic testing.
- History of mantle chest radiation before age 30 years.
CPM can be considered for those at lower risk of CBC
- Gene carrier of non-BRCA gene (e.g., CHEK-2, PALB2, p53, CDH1).
- Strong family history, patient BRCA negative, no known BRCA family member.
CPM may be considered for other reasons
- To limit contralateral breast surveillance (dense breasts, failed surveillance, recall fatigue).
- To improve reconstructed breast symmetry.
- To manage risk aversion.
- To manage extreme anxiety. (This may be better managed through psychological support strategies.)
CPM should be discouraged
- Average-risk woman with unilateral breast cancer.
- Women with advanced index cancer (e.g., inflammatory breast cancer, T4 or N3 disease, stage IV disease).
- Women at high risk for surgical complications (e.g., patients with comorbidities: obesity, smoker, diabetes).
- Woman tested BRCA negative with a family of BRCA-positive carriers.
- Male breast cancer, including BRCA carriers.
These guidelines are up to date as of 10/10/19.
Questions To Ask Your Health Care Provider
- What is my risk of developing cancer in my other breast?
- What complications may occur if I undergo contralateral prophylactic mastectomy?
- I have invasive breast cancer; what are all of my options?
- I have been diagnosed with breast cancer before age 45. Should I consider genetic testing before I make decisions about surgery?
- I do not have a BRCA mutation, but I have a very strong family history of breast cancer. Should I consider contralateral prophylactic mastectomy?
- I have a BRCA mutation, but I would like to avoid mastectomy. What are my risks for a second breast cancer?
FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.