Headlines & Helpful Information
By: Dr. Ann Partridge
Guest blog from Komen Scholar Dr. Ann Partridge, Associate Professor, Department of Medicine, Harvard Medical School; Director, Program for Young Women with Breast Cancer, Susan F. Smith Center for Women’s Cancers; Director, Adult Survivorship Program Dana-Farber Cancer Institute
A breast cancer diagnosis can be a really scary thing. Even though doctors and statistics can reassure women that most will be ok in the long run, many women worry that, “they were the one that got breast cancer, and they may be the one that hears from it again.” And, understandably, they may want to do every possible and reasonable thing they can to reduce that chance.
One potential option for reducing the risk of breast cancer that has received increasing attention in recent years is “contralateral prophylactic mastectomy” or CPM. CPM is a procedure where both breasts are removed (bilateral mastectomy) even though breast cancer is only in one breast (unilateral breast cancer).
Rates of CPM have increased dramatically in the past decade, drawing the attention of doctors who care for women with breast cancer, as well as researchers trying to understand this trend. Generally speaking, is CPM good for women in the long run? Or is there something we should do to reverse this trend? There are a number of reasons women may choose to remove or not remove a healthy breast, and women should understand the risks and benefits of CPM in order to make the best decisions for their lives.
So, what has research shown us so far? First, and most importantly, studies have shown that, in the long run, removing a woman’s healthy breast when she has breast cancer in the other does not improve overall survival. This is because the vast majority of breast cancer survivors will not develop a new breast cancer in the other breast (which is essentially the only scenario a woman is preventing when she removes the healthy breast). Exceptions could include women with a known genetic predisposition to breast cancer like those with a BRCA 1 or BRCA 2gene mutation, whose risk of a new breast cancer occurring in the other breast is higher.
Further, a woman who has been previously diagnosed with breast cancer is generally being watched closely with more frequent follow-up screenings. So, even if a second breast cancer develops in the healthy breast, it is usually caught early, and she will be treated quickly.
Many women I see in my clinic that are making surgical decisions think they are reducing the chances that their breast cancer will come back by removing the other, unaffected breast. But this is not the case. For most women, if a breast cancer is going to come back, it is usually not to the other breast. As women learn this, they often think differently about the idea of removing their healthy breast.
Another thing to consider is that any potential decrease in risk resulting from CPM does not decrease the possibility of the primary breast cancer spreading or recurring elsewhere in the body (metastasizing).
There are a few key things women should know about mastectomy as well. Although mastectomy is a safe procedure and major complications are rare, there are potential negative consequences, including cosmetic concerns, and other potential long-term effects such as numbness of the chest skin, swelling, chronic pain and decreased motion of the upper arm. Given most women also opt for reconstruction, it’s important to consider the extended recovery time, added surgical complications, and decreased strength or function due to muscles being moved or stretched.
On the other hand, women have shared a number of reasons with us that cause them to consider CPM. For some, the idea of having any chance of a new breast cancer in their healthy breast is very anxiety-provoking, as is consideration of follow-up mammograms to screen for new breast cancer in the future. They would prefer to never have to deal with that again and are willing to undergo CPM to prevent it. Cosmetic concerns may also be a driver, with the desire to have two reconstructed breasts that look similar instead of one treated breast and another natural breast. Although, plastic surgeons today can do much to help recreate a more natural look, ensuring both breasts looks similar and symmetrical.
Recent studies have indicated that fear of recurrence and anxiety are strong predictors of whether women will choose CPM. Improved education and counseling about the risks and benefits of CPM, as well as increased awareness and management of anxiety surrounding breast cancer diagnosis and treatment, are likely to help women understand their risks more fully and make decisions consistent with their preferences and values.
Researchers are working on tools called “decision aids” to help women to make the best decisions for themselves, in conjunction with their doctors, which may be particularly helpful for women going through this difficult process in the future.
For any woman dealing with this decision, it is important to learn the facts and discuss their concerns with their doctors in order to make the best decision. I also always recommend that women take their time to be sure. Sometimes this means waiting to take action with the other breast, because once it’s removed, you can’t put it back on!
Ultimately, this is a very personal decision and women need to be supported with information and emotional support to do what is best for them.
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