Thinking of removing your other breast after cancer?
A diagnosis of breast cancer is always scary. There are invasive treatments to consider, emotional upheaval about possible changes in body image and, most importantly, a fear of dying.
Numerous studies show that many patients make decisions based on fear or out of a desire to take control of the situation. Because of these things and the very highly publicized double mastectomy that actress Angelina Jolie had done as a proactive move to prevent breast cancer, more breast cancer patients are asking doctors to remove their second healthy breast, a procedure called contralateral prophylactic mastectomy.
But that action is not always advisable, according to breast cancer specialist Jill Oxley, MD, of Cape Cod Surgical Associates in Hyannis.
“There are a lot of women who fear that their risk of getting cancer in their other breast is a lot higher than it really is,” she said. “We need to get rid of the misconception that removing an unaffected breast is going to improve the outcome.”
The American Society of Breast Surgeons did a review of the literature and a survey of members at their last society meeting, and published a position statement [pdf] recommending against removing a healthy breast for average risk women with unilateral breast cancer.
The risk of getting cancer in the second breast is about 5 percent, Dr. Oxley said. Another misconception is that removing both breasts ensures a person won’t get breast cancer, she explained.
“A contralateral prophylactic mastectomy reduces the risk of cancer in that breast by 90 percent; not completely,” she said.
There are several exceptions to the surgeon’s society recommendations. Women who have the BRCA1 or BRCA2 gene mutations are at a higher risk of getting cancer in the first place, so they have a higher risk of getting it again.
“We do a more intensive screening program for hereditary and familial breast cancer through the Cuda Women’s Health Center with the goal of identifying women who have genetic mutations who are at increased risk of developing breast cancer – ideally before they have developed cancer,” Dr. Oxley said.
But even having one or more of the BRCA genes would not be a mandate for bilateral mastectomy, she said. Women with the BRCA mutations are counseled that bilateral mastectomy is an option, but they can also opt for more intensive screening programs, as well. That would include a combination of once-a-year mammograms and MRIs.
“There are other genes that are associated with an increased risk but they are not as high as the BRCA genes, so everyone is counseled individually based on their family history and their previous breast history,” Dr. Oxley said. “We have to think about the age of the patient and her general medical health too.”
Another exception to the recommendation is women who have had many biopsies over the years whose mammograms are hard to read because they have dense breasts. For some of these women, the anxiety of biannual imaging and potentially needing other procedures down the road is more than they want to accept.
The final big exception to the American Society of Breast Surgeons recommendations is women who want to have both breasts removed for reconstruction purposes, Dr. Oxley said. Surgeons can achieve better symmetry when both breasts are taken, especially for women with larger breasts.
Most women do not elect to have reconstruction, but it’s a very personal decision, she said. There is no difference in outcome or treatment either way. With prosthetic devices, most women with small to medium breasts can have a very good cosmetic outcome either with or without reconstruction.
“Just reassure the average-risk woman that she does not need the opposite breast removed, but we can still consider it when someone is very concerned about the need for the ongoing surveillance or for symmetry,” she said.