It’s becoming more of a growing trend for a woman with breast cancer to request to have her other healthy breast removed in order to lessen her risk of cancer recurrence.  However, the American Society of Breast Surgeons is urging restraint on this procedure and recommends only certain women who have cancer in one breast should remove the other breast without cancer.  Their new position statement on this topic was published in the journal Annals of Surgical Oncology.

A procedure known as contralateral prophylactic mastectomy, is a procedure to remove a healthy breast in which both breasts are removed - the breast with cancer and the opposite, healthy breast - during surgery.  It’s a preventative procedure women may decide to do in response to developing cancer in the other breast.

It is understandable that a woman may choose to remove her healthy breast, believing this will reduce any chance of breast cancer occurring again.  Yet the surgeon’s group discourages this in women who are at average-risk where there chance of developing breast cancer in the healthy breast is only 0.1 to 0.6 percent a year.

Women with breast cancer will have many questions regarding the chance of recurrence of the cancer in the opposite healthy breast.  This is where a good rapport of communication and trust is vital between the patient and her surgeon where the treatment plan must be based on an analysis of the risks and benefits of contralateral mastectomy.  Clear, understandable information outlining the pros and cons should be provided to all women discussing all treatment options available and what her individual recurrence risks are. 

The decision to perform a contralateral procedure must be based on several factors:

·         Does the woman have a strong family history of breast cancer

·         Does she have dense breasts

·         Does she have extreme anxiety over recurrence of cancer

·         Are there concerns with breast reconstruction symmetry

·         Anxiety over annual breast screenings

 A high-risk group where surgery for contralateral removal of the healthy breast is strongly warranted is for women who carry the BRCA 1 or BRCA 2 gene mutations.  Specific inherited mutation in BRCA 1 and BRCA 2 increase the risk of female breast and ovarian cancers.  Together these mutations account for about 20 to 25 percent of hereditary breast cancers and about 5 to 10 percent of all breast cancers.  These harmful mutations can be inherited from either a person’s mother or father.

 One reason why the breast surgeons are hesitant to automatically perform a contralateral procedure on any woman who wants it is that the surgery does not improve their cancer outcome as research shows no gains are made in preventing cancer when the heathy breast is removed. 

 The decision whether to remove a healthy breast should always be based on the patient’s preference.  If the woman has been thoroughly informed on the risks and benefits, all treatment options available and recurrence risks and she still wants to proceed with the surgery, this is usually the final agreement.