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    New Debate on Breast Removal to Prevent Cancer

    Study Suggests Counseling May Change Patients' Opinions About Prophylactic Mastectomy
    By
    WebMD Health News
    Reviewed by Laura J. Martin, MD

    March 26, 2010 -- Counseling on actual recurrence risk can lead to a reduction in the number of women who choose to have both breasts removed when only one breast is affected by cancer, new research shows.

    Many breast cancer survivors believe that their risk of developing breast cancer in their other breast is about five to 10 times higher than it actually is. As a result, more and more women are opting for a prophylactic mastectomy (surgical removal) of the unaffected breast, even though there is no evidence that this will affect overall chances of survival among women at low or moderate risk for breast cancer recurrence.

    Ajay Sahu, MD, a breast surgeon at the Frenchay Hospital in Bristol, England, noticed this trend in his practice and sought to determine why 27 women aged 31 to 65 who underwent a mastectomy on the breast with cancer were also requesting the surgical removal of the other breast, and whether or not a "cooling off period" and counseling would help them understand their actual risk of recurrence and lead them to change their minds.

    It did.

    After one year, 23 of these women chose not to have a prophylactic mastectomy, Sahu reported Thursday at The European Breast Cancer Conference in Barcelona, Spain. Women all received chemotherapy and/or radiation after their mastectomy to kill any errant breast cancer cells, and they were counseled and followed for one year. After one year, women who still wanted to have their other breast removed were offered the surgery.

    Removing Both Breasts: Reasons for Decision

    The women, all of whom were considered at low or moderate risk for breast cancer recurrence, were asked why they wanted to have both breasts removed at the time of their initial diagnosis.

    • Twelve women in the study said they wanted the other breast removed because of family history of breast cancer.
    • Four women said that a family member or friend had a bad outcome with a single-breast mastectomy.
    • One woman wanted to avoid radiation.
    • Three women wanted a prophylactic mastectomy due to their young age, even though they were considered low-risk for recurrence.

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