Remove Second Breast to Prevent Cancer?
Study Probes First Breast Cancer and Decision to Get Preventive Mastectomy in Second Breast
WebMD News Archive
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
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