Q&A: Surgical Removal of a Healthy Breast
CancerWise - April 2009
If a woman has breast cancer in one breast, should she have the healthy breast surgically removed to prevent the possibility of cancer in the future?
The procedure is known as contralateral prophylactic mastectomy (CPM). The decision whether to have one includes many factors, both emotional and physical.
According to researchers at M. D. Anderson, almost 3% of women in the United States who are diagnosed with cancer in one breast choose to have CPM, a figure that increased 150% from 1998 to 2003.
Kelly Hunt, M.D., chief of the Surgical Breast Section, and her associates at
M. D. Anderson recently developed a method to help calculate the likelihood of cancer developing in the opposite breast. She spoke with CancerWise about the procedure and the decision-making model.
Why is this model important?
Many women opt for CPM out of fear. Although this may be understandable, I believe women should be better informed about the risks of the procedure and the potential for developing cancer in the opposite breast.
This is not a trivial procedure. Even after breast reconstruction, the chest will not look the same. In addition to appearance, it changes the sensations across the chest wall.
The decisions women make and the treatments they choose should be the very best options for them, based on the best information available.
For instance, age is a factor and may be strong enough to help some women make the decision.
Family history also is important, and some women may be appropriate candidates for genetic testing to evaluate for mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.
What did your study entail?
We reviewed the cases of 542 women with breast cancer in one breast who had CPM at M. D. Anderson from January 2000 to April 2007.
Of the women in this group:
- 435 had no cancer in the opposite breast
- 25 had cancer in the opposite breast
- 82 had abnormal cells in the opposite breast
What else did your study find?
We found cancer in the opposite breast in about 5% of the women. This was undetected by mammography prior to surgery.
A few factors seemed to predict which patients were at higher risk of having breast cancer in the opposite breast.
Patients at higher risk had:
- More than one focus (site) of cancer in the breast
- Cancer that begins in milk-producing lobules
- A five-year Gail risk score higher than 1.67%
The Gail model is an online calculator that can help predict the risk of developing breast cancer by examining specific factors like age and family history. Although it was designed for women who have not had breast cancer, it turned out to be helpful in our research.
When do women have to decide if they will have the opposite breast removed?
There’s no time limit. Some women have both breasts removed at the same time, but the surgery to remove the opposite breast usually can be performed at any time.
What else should women know about making the decision?
The biggest misperception is that women who are diagnosed with cancer think they are certain to get cancer in the other breast. Often they are not aware of treatment options.
Many breast cancer treatments, such as chemotherapy and hormonal therapy, also reduce the risk of developing a cancer in the opposite breast.
M. D. Anderson resources:
- Breast Cancer Risk Assessment Tool (National Cancer Institute)
CancerWise - April 2009
- Decision to Remove Healthy Breast Is Personal
- Q&A: Surgical Removal of a Healthy Breast
- Old Science, New Angle Prevent Nausea
- Melanoma Study Proves Good as Gold
- Genes Predict Pancreatic Cancer Risk, Outcome
- Drug Combo Ramps Up Leukemia Therapy
- Tibetan Meditation Takes Patients ‘Home’
- Selenium, Vitamin E Don’t Prevent Prostate Cancer