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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 done."

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 cancer.

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 it."

"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 treated.

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