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Changing Paradigms in the Management of Breast Cancer pp 33–46Cite as

Contralateral Prophylactic Mastectomy: Current Perspectives

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Abstract

There has been an increasing trend in the use of contralateral prophylactic mastectomy (CPM) in the United States for women diagnosed with unilateral breast cancer particularly among young women. Approximately a third of women <40 years old are undergoing CPM in the United States. There is conflicting data on the survival benefit to CPM since all studies are retrospective and subject to selection bias. The contralateral breast cancer (CBC) rate for most women is low at 10 years as demonstrated in multiple population based studies and clinical trials. Most studies have shown that the CPM trend is mainly patient driven, which reflects a changing environment for newly diagnosed breast cancer patients where patients are undergoing many more diagnostic tests and consultations prior to surgery. The most common reason that women choose CPM is based on misperceptions about CPM’s effect on survival and overestimation of their contralateral breast cancer risk (CBC). Fear of recurrence is also a big driver of CPM decisions. Women are mostly satisfied with undergoing CPM, but complications and subsequent surgeries with reconstruction have been associated with dissatisfaction with CPM. The most common reasons surgeons discuss CPM with patients are family history or BRCA mutation carrier, but approximately 50% of surgeons feel uncomfortable performing CPM at some point in their practice. Counseling patients on CPM must involve adequately informing patients, weighing patient values and treatment preferences and involving patients directly in the decision making process. Patients at higher than average risk for a CBC may be candidates for CPM, but CPM should be avoided in those patients with an average risk of a CBC.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Katharine Yao MD

  2. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Katharine Yao MD

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  1. Associate Professor of Surgery, Director Breast Care Center, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Marissa Howard-McNatt

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Yao, K. (2018). Contralateral Prophylactic Mastectomy: Current Perspectives. In: Howard-McNatt, M. (eds) Changing Paradigms in the Management of Breast Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-60336-0_3

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