When breast cancer is diagnosed in one breast, a common question is whether the unaffected breast should also be removed. This decision, known as a contralateral prophylactic mastectomy (CPM), is complex and personal. It involves weighing medical facts against individual circumstances and preferences. Understanding its implications is crucial for navigating breast cancer treatment.
Understanding Contralateral Prophylactic Mastectomy
Contralateral prophylactic mastectomy (CPM) involves surgically removing the healthy breast when cancer is diagnosed in the other. This procedure aims to reduce the risk of developing a new primary breast cancer in the unaffected breast. It is distinct from the mastectomy performed on the cancerous breast, which treats the existing cancer.
The primary purpose of CPM is to prevent a future cancer, not to treat the current one. This distinction is important for patients considering their surgical options.
Factors Influencing the Decision
Several medical and personal factors guide the decision to consider CPM. Genetic predisposition plays a significant role, particularly with inherited mutations in genes such as BRCA1, BRCA2, PALB2, CHEK2, ATM, and TP53. These mutations substantially increase the lifetime risk of developing breast cancer in both breasts. For instance, women with BRCA1 or BRCA2 mutations can have a lifetime breast cancer risk as high as 72%.
A strong family history of breast cancer, even without identified genetic mutations, can also influence the decision. Patients with multiple close relatives affected by breast cancer may perceive a higher personal risk. Certain pathologies of existing cancer, such as lobular carcinoma in situ (LCIS), indicate an increased risk of developing cancer in either breast, including the contralateral one. LCIS is considered a marker for increased risk of future invasive cancer, with a lifetime risk potentially exceeding 20%.
Patient anxiety and the desire for peace of mind are also personal considerations. Some women choose CPM to reduce the psychological burden of worrying about future cancer development in the healthy breast. Additionally, the desire for breast symmetry after reconstruction can be a factor, as achieving a balanced appearance may be easier when both breasts are reconstructed simultaneously.
Potential Advantages and Disadvantages of CPM
A primary advantage of CPM is the reduction in the risk of developing a new primary breast cancer in the healthy breast. For individuals with specific genetic mutations, this risk reduction can be substantial, with studies indicating approximately a 90% reduction in risk for BRCA1/2 mutation carriers. This reduction can offer peace of mind for some patients, alleviating concerns about future diagnoses.
However, CPM also carries several disadvantages, including general surgical risks such as infection, bleeding, pain, scarring, and potential nerve damage leading to loss of sensation. The recovery period can be extended compared to a unilateral mastectomy, involving more discomfort and time away from daily activities. Body image concerns and loss of sensation in the reconstructed breast are potential negative impacts.
For the majority of women with unilateral breast cancer, CPM does not improve overall survival. It primarily reduces the risk of a new cancer, not the recurrence or spread of the existing disease. Therefore, for many individuals, undergoing CPM might represent overtreatment, as their individual risk profile for a new cancer in the healthy breast may be low, especially if their primary cancer treatment includes therapies like chemotherapy or hormone therapy.
Navigating the Decision with Your Healthcare Team
Making an informed decision about CPM involves a collaborative discussion with your oncology team. This shared decision-making process empowers patients by providing evidence-based information and considering individual preferences. Your team, including surgeons, medical oncologists, radiation oncologists, and genetic counselors, can offer comprehensive insights.
It is important to ask specific questions about your personal risk of developing a new cancer in the unaffected breast, the procedure details, and the expected recovery. Discussing all available alternatives and their implications for your specific cancer type and genetic profile is also beneficial. The decision should be highly individualized, taking into account your medical situation and life priorities. Seeking second opinions can also provide additional perspectives and reinforce confidence in the chosen path.