Remove Second Breast to Prevent Cancer?
Study Probes First Breast Cancer and Decision to Get Preventive Mastectomy in Second Breast
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
Gralow and Vogel also point out that when breast cancer is diagnosed, many
doctors now perform MRI scans of both breasts. Those scans help show the extent
of breast cancer in the affected breast and check the other breast for
Hunt's study started before that practice became common, so not all of the
patients got MRI scans before opting for preventive mastectomy. Genetic testing
also wasn't a routine procedure for the patients in Hunt's study, and isn't
recommended for most breast cancer patients.
No Rush to Decide
Hunt, Gralow, and Vogel encourage women to take their time in deciding
whether or not to get a contralateral prophylactic mastectomy and to focus on
treating the breast cancer that they already know they have.
"A lot of women will come to my office and immediately say, 'Why don't
you just take both breasts off?' and I try to explain to them that depending on
their risk, not everyone needs that dramatic measure," Hunt says. "I
always try to get patients to give much more time and consideration to
"There shouldn't be this sense that we have to do this [preventive
mastectomy] right now," Vogel says. "This is not urgent, it's not
life-threatening immediately ... it can be done after the primary therapy, when
you get a little emotional distance from it and you can make these decisions
with a calm heart."
Gralow notes that preventive mastectomy hasn't been shown to improve breast
cancer survival, though it does cut the odds of getting breast cancer again.
That's because if a recurrence happens, chances are it would be found and