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Prophylactic Mastectomies

Posted 5/9/2013

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  I have written before about the increasing incidence of prophylactic bilateral mastectomies for women with early breast cancer who "only" need surgery on one side. It is terrifying to hear the cancer word, and most of us are frantic to do whatever we can to protect ourselves now and to insure our future good health. For some women, that translates to a strong wish to "get rid" of the other breast, a possible source of another crisis in the future. It may not be soothing to be told that the future risk of a second cancer in the other breast is very small, about 1% per year, and that breast cancer almost never goes to the other breast. The worries of cancer spreading are that it might metastisize to another part of the body; removing the second breast does nothing to minimize that risk.

  There are occasional situations in which the medical recommendation would be a second mastectomy, usually these are associated with a positive gene (BRCA1 or BRCA2) mutation. Even for women with a positive gene mutation, there is the option of careful follow-up, and many women opt to save their breast (s). This article from MedScape reports a recent study presented at the American Society of Breast Surgeons meeting. The important finding is that opting to remove a healthy breast with a prophylactic mastectomy may result in delays of chemotherapy and/or radiation for the diagnosed breast cancer. The rate of complications post bilateral mastectomy is higher than that of single mastectomies, and this delay might be a serious problem in some situations.

  Here is the start of the article and a link to read more:

Time to Rethink Contralateral Prophylactic Mastectomy?

NEW YORK (Reuters Health) May 03 - Women with early cancer in one breast who opt for prophylactic mastectomy of  their healthy breast risk unnecessary complications that may impact the timing and delivery of adjuvant chemotherapy  and radiation, researchers warn.
In a study of more than 4,200 breast cancer patients, they found that women making this choice had twice as many  postoperative complications as women undergoing a single mastectomy.
The findings are significant because the risk of future cancer in the opposite breast of a unilateral breast cancer patient,  without other risk factors, is "extremely low, less than 1% per year," study leader Dr. Fahima Osman from University of  Toronto said. "There is no strong evidence that suggests that this procedure has a survival benefit in the majority of  women with breast cancer."
It's "imperative" to discuss potential complications with women contemplating contralateral prophylactic mastectomy, Dr. Osman added.
She discussed the study findings Thursday during a media briefing at the American Society of Breast Surgeons (ASBrS)  annual meeting underway in Chicago.  Dr. Deanna Attai, ASBrS board member and director the Center for Breast Care, Inc. in Burbank, California, who
moderated the briefing, said the study is "very important as the mastectomy rate does seem to be increasing in this
country. As more and more women are choosing prophylactic mastectomy, we do need to start looking at what the
potential complications and risks of additional surgery are."

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