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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. 

Seven women had lobular breast cancer, a cancer that begins in the milk-making glands (lobules) of the breast, and can be difficult to diagnose by mammogram.

After counseling and the cooling-off period, "[women] had an understanding of actual risk of bilateral breast cancer, an understanding that the risk can be reduced by treatment and surveillance by annual mammography, and that no survival benefit is conferred by the operation," Sahu says.

"I felt that the time of diagnosis was a moment of increased stress and not the right time to make such a decision," he says in a news release. "The 'cooling off period' actually helped to reduce anxiety (although we did not explore this specifically) and helped the women to be comfortable with the decision they made in the end," he says.

He plans to continue this study on more women to see if the results hold.

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