Thursday, March 11, 2010

After Cancer, Removing a Healthy Breast

On March 8, 2010, Tara Parker-Pope wrote an interesting article in the NY Times (http://well.blogs.nytimes.com/2010/03/08/after-cancer-women-remove-healthy-breast/) about the increasing frequency of what is called contralateral prophylactic mastectomy. This refers to removal of the healthy breast on the other side at the time of therapeutic mastectomy for cancer. She describes that the percentage of women requesting this procedure has doubled in the past 10 years. According to a University of Minnesota study presented last week in St. Louis at the annual meeting of the Society of Surgical Oncology, 10% of women in their 40s requested contralateral prohylactic mastectomy at the time of breast cancer surgery.

Parker-Pope goes on to suggest that women may be choosing this option because they think that it will increase their survival, or as she recounts a surgeon saying; "Women say the reason they’re going to have both breasts removed is because they want to see their children graduate or watch their grandchildren grow up." We do know that having a diagnosis of breast cancer in one breast does confer a higher lifetime risk of breast cancer in the other breast, on the order of 0.6 to 1 percent per year. But she states that since more cancers are being diagnosed at an earlier stage, the risk of dying from a breast cancer in the opposite breast is very low.

The reality is (as she does mention in the article) that many women are choosing this option because they "never want to experience the stress of a mammogram of biopsy." While they may understand that the risk of dying from breast cancer is related to the stage of the breast cancer that they are having treated, and that survival from early stage breast cancer is the same for breast conservation therapy and mastectomy; "Why would you want to risk getting cancer a second time?” a patient interviewed in her article asks.

As plastic surgeons, we explain that contralateral prophylactic mastectomy at the time of therapuetic mastectomy allows improved potential of symmetry of the recontruction. Even so, most of the patients that I see in consultation have already decided to proceed with contralateral mastectomy at the time of therapeutic mastectomy for reasons relating to the emotional toll of continued surveillance of the normal breast every 3 to 6 months. As I have described in previous posts, providing patients with all the necessary information before their primary surgical treatment allows for improved surgical decision making.

6 comments:

breast reconstruction surgery Los Angeles said...

The fear of having cancer is the other side makes them take over this decision.the surgeon can explain the pros and cons of it.In most cases the other one is not affected I think.

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