Mayo Clinic: My daughter was diagnosed with breast cancer at
54 and had surgery to remove one breast. Her surgeon told her
that it wasnít necessary to remove both breasts, because she
was not at high risk for developing cancer on the other side.
How can that be true? Isnít a recurrence likely if she still
has breast tissue on the other side?
fact that your daughter developed cancer in one breast doesnít
mean she is at high risk to develop cancer in the other
breast. Her risk of developing a new cancer in the breast that
remains after surgery is lower than most people think (around
0.2 to 0.6 percent per year). And the risk that the breast
cancer will come back in a different part of her body is not
changed, whether or not her healthy breast is removed.
technical term for this procedure ó surgically removing a
healthy breast in a woman with breast cancer ó is called a
contralateral prophylactic mastectomy, or CPM. Many women
diagnosed with breast cancer opt to have CPM, because they
believe it just makes sense to remove both breasts when cancer
is detected in one.
has found, though, that for women with an average risk of
breast cancer, CPM doesnít prolong life, nor does it change
the risk of cancer coming back. In fact, for this group,
studies show that, even though they have cancer in one breast,
the risk of cancer developing in the other breast is still
relatively low. For these reasons, the American Society of
Breast Surgeons recently recommended against CPM for
average-risk women with cancer in one breast.
speaking, a woman is considered to be at average risk for
breast cancer if she does not have a strong family history of
the disease; does not have a gene that predisposes her to
developing breast cancer, such as BRCA1 or BRCA2; and does not
have a history of radiation therapy to the chest wall at a
young age. If your daughter had any of these, itís likely
her breast cancer risk would be considered high, and a CPM may
the reason for recommending against CPM in average-risk women
is that the procedure itself comes with risks of its own. When
you have CPM, the risks of bleeding and infection due to
surgery are double what they would be if you had a mastectomy
only on one side. Thatís because there are two surgical
sites, rather than one. Given the lack of survival benefit or
improvement in cancer outcomes with CPM in average-risk women,
undergoing surgery and exposing yourself to those surgical
risks may not be worth it.
course, other factors beyond future cancer risk can come into
play when deciding whether to have CPM. For example, when
women have a mastectomy on one side and opt for breast
reconstruction, breast symmetry may be a consideration. Some
women prefer to have both breasts removed and reconstructed
during the same surgical procedure, so the appearance of their
breasts is similar. That is certainly a valid topic to discuss
with your surgeon if youíre considering CPM. There are
alternatives for the other breast to achieve symmetry,
including breast reduction or breast augmentation, that
preserve breast sensation.
bottom line is that women who are considering CPM should have
a detailed conversation with their surgeons about what they
want to achieve with the surgery. If the goal is to prolong
survival or lower future cancer risk, then CPM may not be the
right choice. But that is not to say no one who falls in the
average-risk category should ever have the procedure. Just
make sure that going through with CPM can realistically meet
your long-term objectives.