Choosing Contralateral Mastectomy

Contralateral prophylactic mastectomy (CPM) is a procedure in which a woman with breast cancer in one breast has both the affected breast and the healthy breast removed at the same time. Between 1998 and 2008, CPM procedures increased 15 percent per year among breast cancer patients in the United States. While removing a healthy breast reduces the risk of developing cancer in that breast, data suggest that even without surgery the actual risk of such cancer developing is, for most women, very low. As such, CPM does not often improve survival among women who elect it. And while mastectomy is generally a safe procedure, it does bring with it potential adverse effects, including quality of life complications such as tingling in the chest, chronic pain, and effects on self-image, self-esteem and sexuality.

Given all of this information, researchers decided to examine women’s reasons for electing to have CPM. Working with the Helping Ourselves, Helping Others: Young Women’s Breast Cancer Study, researchers surveyed 123 women whose family history of breast cancer and genetic mutation status (if they had BRCA1 or BRCA2 mutations) was already known and who had elected to have CPM.1 They found that overwhelmingly women understood and acknowledged that CPM does not improve survival. Paradoxically, despite this understanding these women chose to have the procedure anyway, identifying a desire to extend life and prevent disease recurrence as the main reasons for doing so.

Researchers also found that half of all women surveyed had physicians who never mentioned any reason not to have the procedure, suggesting that health care providers may not be engaging women in conversations about their true risk for contralateral breast cancer.

Interpretations and Implications

Mastectomy is generally a safe procedure, but it does have risks. Combined with risks to quality of life, it is interesting that breast cancer patients with low risk of contralateral breast cancer may elect to remove a healthy breast. This study begins to shed some light on the inner fears and anxieties that drive a cancer patient’s decision making and may have implications for communication strategies aimed at making evidence-based treatment decisions.

Source: Cemal et al. 2013. “A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method,” Plastic and Reconstructive Surgery [131(3):320e-6e].

1 Rosenberg, S.M., et al. 2013. “Perceptions, Knowledge, and Satisfaction With Contralateral Prophylactic Mastectomy Among Young Women With Breast Cancer: A Cross-sectional Survey.” Annals of Internal Medicine [159(6):373-81].

jess Werder headshot BWJessica Werder, Health Researcher, Community Outreach Manager

Jess Werder earned an M.P.H. from State University of New York (SUNY) at Albany, is Community Outreach Manager for the Fairfax County Health Department in Virginia. With the Peace Corps in Nicaragua from 2008-2010, she was a Community Health Promoter whose responsibility was to design, implement and evaluate department-wide community health programs, then, on her return to the States, continued this work with the Association of Farmworker Opportunity Programs (AFOP). She was a graduate fellow at the SUNY Center for Women in Government and a Lecturer in the Department of Women’s Studies at U Albany. She now lives in the Washington, DC area with her husband and two young children. Jess currently researches and writes the “Recent Research” column for Capital Region Action Against Breast Cancer! (CRAAB!), a community-based non-profit created in 1997 by a diverse group of caregivers, health practitioners, educators, advocates and breast cancer survivor. BCC is pleased to republish some of these insightful analyses in our own Research Briefs.

Be Sociable, Share!

Articles & Posts