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Little Value from Prophylactic Mastectomy

Posted 10/9/2013

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  I have written many times about the rising choice of prophylactic mastectomies for women who are also offered the option of lesser surgery. Note: the situation of women who carry a genetic mutation, BRCA1 or BRCA2, is obviously different. We are thinking here about women who are diagnosed with breast cancer, told by a surgeon that a lumpectomy/wide excision and radiation is an equally effective treatment, and who opt for either one or even two mastectomies. No matter what else is said, it is clear that these women believe that they are increasing their chances to stay healthy by having more surgery.

  A study from the University of Minnesota has just been reported at the annual American College of Surgeons conference in Washington, DC. The finding is that the survival benefit, over twenty years, is less than one percent. This is important information that needs to be shared with any woman struggling with the decision.

  Here is the beginning of a report from Medscape and a link to read more:

Prophylactic Mastectomy Offers Minimal Gain in Breast Cancer

WASHINGTON, DC — The survival benefit for contralateral prophylactic mastectomy among women who do not have a BRCA gene mutation is less than 1% at 20 years, a new computer model suggests.

"We hope that by providing women with accurate and easily understood information about the potential benefits of contralateral prophylactic mastectomy, this may impact current trends," said Pamela Portschy, MD, from the University of Minnesota in Minneapolis.

These findings, which come at a time of increasing demand for the procedure by women with cancer in one breast, were presented here at the American College of Surgeons 2013 Annual Clinical Congress.

"This model provides long-term survival information to physicians and their patients when discussing breast cancer risk-reduction strategies," Dr. Portschy explained.

Her team used published data to compare the risks for contralateral breast cancer and mortality with and without prophylactic mastectomy in women 40 to 60 years of age with early-stage breast cancer and without the high-risk BRCA mutation. The analysis took age, breast cancer stage (I or II), and estrogen-receptor status into account.


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