Avoid routine double mastectomy when possible

Volume 5, Issue 4, 2016

Summary

Consensus group urges weighing pros, cons and patient preference in unilateral breast cancer.

Photograph of Judy C. Boughey, M.D.

Judy C. Boughey, M.D.

A position paper issued by the American Society of Breast Surgeons recommends against contralateral prophylactic mastectomy (CPM) for average-risk women with breast cancer in only one breast.

The recommendation on prophylactic mastectomy, published online July 28, 2016, in the Annals of Surgical Oncology, addresses the growing trend to remove the healthy breast (contralateral prophylactic mastectomy) along with the breast with breast cancer.

"Contralateral prophylactic mastectomy is a growing trend that has generated significant discussion among physicians, patients, breast cancer advocates and media," said Judy C. Boughey, M.D., a breast surgeon at Mayo Clinic in Rochester, Minnesota, and lead author of the position paper.

"Our group examined and summarized the data and developed guidelines about the appropriateness of prophylactic surgery," Dr. Boughey said. "Our goal was to provide a framework for physicians to discuss CPM with patients. It is important for patients to understand that CPM does not improve their cancer outcome and to understand the pros, cons and alternatives to CPM."

The American Society of Breast Surgeons recommends that for each patient, surgeons make a clear recommendation for or against contralateral prophylactic mastectomy from a medical standpoint.

In addition, the procedure generally should be discouraged in average-risk women whose chance of developing breast cancer in the healthy breast is 0.1 percent to 0.6 percent a year. The American Society of Breast Surgeons recommends counseling for breast conservation for all medically appropriate patients and the use of tumor-shrinking or reconstructive approaches to help facilitate breast conservation, when appropriate.

The position paper from the American Society of Breast Surgeons acknowledges that the patient's values and preferences should be an important part of a shared decision-making process. The paper provides a detailed template for these discussions, which it highly recommends surgeons follow.