Many Women Choose Contralateral Prophylactic Mastectomy When It's Not Indicated — Physician’s First Watch

Medical News |
May 22, 2014

Many Women Choose Contralateral Prophylactic Mastectomy When It's Not Indicated

By Kelly Young

Many women with breast cancer strongly consider a mastectomy on the unaffected breast, and many of those go on to have the procedure, even though few are at risk for contralateral breast cancer, according to a JAMA Surgery study.

Researchers identified roughly 1400 women in Detroit and Los Angeles with stage I–III breast cancer and surveyed them about 4 years after their diagnoses. Among the findings:

  • About 19% of the patients considered undergoing contralateral prophylactic mastectomy (CPM).

  • Some 32% of women who considered CPM had the surgery.

  • Of those who elected to undergo CPM, just 31% had a clinical indication for it.

  • Factors associated with increased likelihood of CPM versus other breast surgeries were white race, receiving an MRI, higher education, high worry about recurrence, first-degree relatives with breast or ovarian cancer, and genetic testing (positive or negative).

Commentators write: "While CPM might be considered overtreating women without clinical indications, it might still be the right choice for some women for risk reduction, cosmetic, and/or emotional reasons."

Reader Comments (2)

Kirsten Bollam, MD Physician, Internal Medicine

"... The growing rate of CPM has motivated some surgeons to question whether performing an extensive operation that is not clinically indicated is ...." This comment comes from a field of surgery (at least the reconstructive surgery part) that routinely does surgery on healthy women for breast augmentation or reduction !! As a physician who chose mastectomy and CPM for DCIS at age of 41, fully informed about alternative treatments, the quality of applicable clinical studies and 3 years later still very confident about the decision to reject radiation and hormonal therapy as well as to chose symmetry for my chest, much of the discussion comes across as paternalistic. My physicians would have had no hesitation at all to offer me 5 years of daily hormonal therapy to reduce ipsilateral recurrence/ new contralateral cancer accepting potential devastating side effects. They would have had not problem to offer radiation therapy after BCS with potential difficult choices in case of recurrent disease. Yet even now, every time I talk to a new physician, I am being asked why I had chosen CPM and feel I have to defend my position - which I do with full conviction. I am wondering on how much this discussion is unconsciously driven by the believe that a woman should not choose to have the symbol of femininity and fertility cut off. I hence agree with the commentators and wish that treating physicians have the utmost comprehensive understanding and insight.

Mary Ann Hart, MSS Other Healthcare Professional, Nephrology, VAPHS, Pittsburgh, PA

As a 2 year survivor of Stage I breast cancer, I chose to have a contralateral mastectomy along with the affected breast. My mass was graded Nottingham score 1, 0 nodes, and was 4mm in size. Very small. My reason for choosing what I did was primarily because I also have a history of mantle radiation therapy for Hodgkin's Lymphoma, Stage IIIb, 40 years ago. I was at risk for another malignancy, and did not want to face lifelong anxiety waiting for it. Though I know the alternatives, I chose piece of mind, in addition to the risk to another breast cancer, and had both native breasts removed. I am much more at ease, and actually like my "new breasts" much better!

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