Remove Second Breast to Prevent Cancer?
Study Probes First Breast Cancer and Decision to Get Preventive Mastectomy in Second Breast
Key Factors continued...
Hunt points out that invasive lobular breast cancer isn't common; it accounts for about 5% of all breast cancers. And she notes that the Gail model was designed to gauge future breast cancer risk for women who haven't been diagnosed with breast cancer; it wasn't intended for use for breast cancer patients.
Hunt says the Gail model may be a "useful tool" for women with breast cancer, but it will take more studies to confirm that. "We're hoping to develop a risk calculator that we can put online that would be useful to clinicians and patients," Hunt says.
"We're learning more and more that all breast cancers are not the same and they really shouldn't all be treated the same," she says. "We have general guidelines that really help to make sure women get the appropriate treatment, but each individual patient has unique factors and features ... that are important to consider."
Breast Cancer Experts Weigh In
Julie Gralow, MD, director of medical oncology at the Seattle Cancer Care Alliance and an associate professor of oncology at the University of Washington, tells WebMD that the risk factors noted in Hunt's study "make sense," but the study "doesn't convince me that we should be recommending" preventive mastectomy based on those factors.
"Nobody would recommend a prophylactic mastectomy in a group that over the next four years only had a 2.4% chance of getting it on the other side," says Gralow, referring to the comparison group in Hunt's study.
Women who have had breast cancer are at "high risk" for another breast cancer, "but 'high' is a relative term," notes Victor Vogel, MD, the American Cancer Society's national vice president for research.
"Whether the Gail model is the appropriate way to estimate that risk is highly debatable," Vogel says. "What you'd want is a study in which patients with a first breast cancer had a Gail model score, and then in five years, you look to see whether the Gail model accurately predicted the number of second breast cancers. And I am not aware that any such study has ever been done."