Who Benefits from Prophylactic Mastectomy?


Having a breast surgically removed when you have breast cancer in the other breast has long been an option, but there appears to be a growing interest among women in the procedure.

The procedure is called a contralateral prophylactic mastectomy. It is done to avoid the possibility of a future tumor in the remaining breast.

Women who are diagnosed with cancer in one breast have an increased risk for a tumor in the other breast as well. Doctors have struggled to determine which women are at highest risk of such an outcome.

The study done by the University of Texas M.D. Anderson Cancer Center in Houston and recently published online in the journal Cancer helps to identify the women most likely to benefit from the prophylactic mastectomy of the “healthy” breast.

The study involved 542 women with breast cancer diagnosed in one breast (unilateral breast). All of the women decided to have this and the other breast (contralateral prophylactic mastectomy). The researchers identified are three factors that increases the chance of cancer in the other breast. These three factors are:

-- having more than one tumor in the same breast at the time of initial diagnosis of breast cancer


-- having invasive lobular breast cancer, which begins in the milk-producing glands called lobules rather than in the milk ducts, and then invades surrounding tissues

-- and having a high score in the so-called Gail model that calculates breast cancer risk and considers things such as age at first menstrual period, age when first child was born and whether close relatives like mother or sister had the disease.

By using the above information, doctors can help patients understand their individual risks and therefore help them make more informed decisions.

Factors that did not help determine the risk of developing a future cancer in the other breasts included: race and hormone receptor status of the cancer.

Breast cancer is the leading cause of cancer death among women worldwide, with an estimated 465,000 dying annually, according to the American Cancer Society. About 1.3 million women are diagnosed with breast cancer per year.

Breast tumors are tested for estrogen and progesterone receptors -- proteins on the outside of a cell that can bind to chemicals, hormones or drugs traveling through the blood. This does help determine which tumors will respond to chemotherapy.

The study did not focus on whether mutations in the genes called BRCA1 and BRCA2 that raise the risk of breast cancer also raised the risk of having cancer later develop in the initially unaffected breast. Often women with these mutations or a strong family history of breast cancer get preventive mastectomies even before any tumor has developed in either breast.

Predictors of Contralateral Breast Cancer in Patients with Unilateral Breast Cancer undergoing Contralateral Prophylactic Mastectomy; CANCER Print Issue Date: March 1, 2009; Published Online: January 26, 2009; DOI: 10.002/cncr.24129 (abstract); Min Yi, Funda Meric-Bernstam, Lavinia P. Middleton, Banu K. Arun, Isabelle Bedrosian, Gildy V. Babiera, Rosa F. Hwang, Henry M. Kuerer, Wei Yang, and Kelly K. Hunt.


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