Vast Majority of Contralateral Prophylactic Mastectomies Unnecessary

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By Sandra Basu

Sarah Hawley, PhD

ANN ARBOR, MI — Are healthcare providers doing enough to educate and advise breast cancer patients on their options, thereby avoiding unnecessary contralateral prophylactic mastectomy?

New research raises questions about the process leading to often unnecessary surgery.

A study led by Sarah Hawley, PhD, a research investigator at the Ann Arbor VA Center of Excellence in Clinical Care Management Research, noted that about 70% of women who have both breasts removed following a breast cancer diagnosis do so even though they face a very low risk of cancer in the healthy breast. The findings were presented at the American Society of Clinical Oncology’s Quality Care Symposium in November 2012.1

“There seems to be some knowledge gaps related to the procedure options that women choose between, and there also seems to be this real fear of breast cancer coming back that seems to be pervasive, regardless of the kinds of treatments that women get and regardless of the likelihood of their cancer coming back,” Hawley, who is also associate professor of internal medicine at the University of Michigan Medical School, told U.S. Medicine.

Contralateral prophylactic mastectomies generally are not recommended for consideration unless there is a family history of multiple members with breast or ovarian cancer or the patient has a positive genetic test for mutations in the BRCA1 or BRCA2 genes. In fact, one 2010 study published in the Journal of the National Cancer Institute suggested that CPM offered a small improvement in five-year breast cancer-specific survival only in young women with early-stage ER-negative breast cancer.

Despite that, research indicates that the procedure has not waned in popularity. A 2010 study published in the Annals of Surgical Oncology found that patients choosing preventive removal of the unaffected breast grew from 0.4% in 1998, to 4.7% in 2007. 2

Breast Cancer

Hawley said that, for the study, she and her co-authors looked at 1,446 women who had been treated for breast cancer and who had not had a recurrence. They found that 7% of women had surgery to remove both breasts. Nearly 1 in 5 had a double mastectomy among the women who had a mastectomy.

“We had a sample of 1,450 women who were in this analysis and of those 110 had a double mastectomy. When we looked at the group that got double mastectomy, 30% of them had a clinical indication, which we defined as having a genetic mutation and/or having a very strong family history, which would be two or more first degree relatives with breast or ovarian cancer,” Hawley pointed out. “The other 70% didn’t have either of those factors.”

As part of the study, researchers asked the women how much worry about cancer recurrence figured in their decision process. The study found that 90% of women who had surgery to remove both breasts reported being very worried about the cancer recurring.

Hawley noted that, except for those who have a genetic mutation or strong family history, removing the second breast likely is of little benefit.

Breast cancer found in one breast after biopsy (shown above) does not usually require prophylactic mastectomy of the other breast. Photo from the National Cancer Institute, Photographer: Linda Bartlett

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