Annals of Surgical Oncology

, Volume 22, Issue 10, pp 3208–3212 | Cite as

Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon

  • Peter Angelos
  • Isabelle Bedrosian
  • David M. Euhus
  • Virginia M. Herrmann
  • Steven J. Katz
  • Andrea Pusic
Breast Oncology


The use of both bilateral prophylactic mastectomy and contralateral prophylactic mastectomy (CPM) has increased significantly during the last decade. Various risk models have been developed to identify patients at increased risk for breast cancer. The indications for bilateral prophylactic mastectomy for patients without a diagnosis of breast cancer include high risk from mutation in BRCA or other breast cancer predisposition gene, very strong family history with no identifiable mutation, and high risk based on breast histology. Additionally, the use of CPM has more than doubled in the last decade, and this increase is noted among all stages of breast cancer, even in patients with ductal carcinoma in situ (stage 0). The risk of contralateral breast cancer often is overestimated by both patients and physicians. Nevertheless, specific risk factors are associated with an increased risk of contralateral breast cancer, including BRCA or other genetic mutation, young age at diagnosis, lobular histology, family history, and prior chest wall irradiation. Although CPM reduces the incidence of contralateral breast cancer, the effect on disease-free survival and, more importantly, overall survival is questionable and underscored by the fact that the reason most patients choose CPM is to achieve “peace of mind.” Newer and effective reconstructive options have made the procedure more attractive. This panel addresses the indications and rationale for bilateral prophylactic mastectomy and CPM, the decision-making process by patients, and ethical considerations. Changes in the physician–patient relationship during the past few decades have altered the approach, and ethical considerations are paramount in addressing these issues.


Breast Cancer Overall Survival Contralateral Breast Cancer BRCA Mutation Carrier Contralateral Prophylactic Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Peter Angelos
    • 1
  • Isabelle Bedrosian
    • 2
  • David M. Euhus
    • 3
  • Virginia M. Herrmann
    • 4
    • 7
  • Steven J. Katz
    • 5
  • Andrea Pusic
    • 6
  1. 1.McLean Center for Clinical Medical EthicsThe University of ChicagoChicagoUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.The Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Division of Surgical Oncology and EndocrinologyWashington University School of MedicineSt. LouisUSA
  5. 5.Departments of Medicine and Health Management and PolicyUniversity of Michigan Medical SchoolAnn ArborUSA
  6. 6.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.Washington University School of MedicineSt. LouisUSA

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