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 continued...
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.
Still, "it's perfectly understandable that maybe women wouldn't want to go through that a second time," Gralow says. "For some women, even a couple percent chance of getting another breast cancer is enough to say, 'I just don't want to deal with it.'"
Gralow says she would support a woman who made that choice, as long as the patient understood the risks and benefits. Her advice: "If you're not sure, you shouldn't do it, because it's permanent."