Removing a Healthy Breast Doesn't Guarantee Breast Cancer Survival

As women with early-stage cancer in one breast increasingly choose to remove both breasts due to concerns about cancer recurring in their healthy breast, rates of contralateral prophylactic mastectomy (CPM) have more than doubled over the past 10 years. But research findings presented at the 2013 Clinical Congress of the American College of Surgeons show that having a healthy breast removed may not provide a survival benefit.

While the risk of developing cancer in the healthy breast is often very low, those at high risk include women with a family history of breast or ovarian cancer and women who test positive for the BRCA1 and BRCA2 gene mutations. No study had looked at women’s decision-making processes prior to CPM until Pamela Rochelle Portschy, MD, Karen Kuntz, ScD, and Todd M Tuttle, MD, MS, FACS, of the University of Minnesota in Minneapolis addressed the topic in their study.

The researchers accessed data from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) and the Surveillance, Epidemiology, and End Results (SEER) program, which include information gleaned from more than 100,000 American women with early-stage breast cancer who have participated in randomized trials throughout the past 30 years. To elucidate CPM’s effect on life expectancy, the researchers conducted an analytic modeling study on women who lacked BRCA gene mutations. Within that group, women who underwent CPM were compared to similar early-stage breast cancer patients who refused prophylactic removal of the second breast.

The researchers examined the risks of developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and the reduction in CBC due to CPM. After estimating the life expectancy gain for women who underwent CPM by age of cancer diagnosis in 1 breast, positive or negative estrogen receptor status, and stage of cancer, they found that the maximum life expectancy gain was 6 months for all scenarios, including age, estrogen receptor status, and cancer stage groups.

While many women choose an aggressive double mastectomy out of fear — despite its greater surgical complexity, longer recovery period, potential for complications, and higher cost — experts worry that a prophylactic procedure is an unnecessary overtreatment.

“I think this decision model study will provide women who are considering these extensive operations with more accurate information about whether or not CPM is going to improve their survival,” Tuttle said.

Tuttle added that the modeling tool can help women and physicians make more informed decisions, and the study results deliver the message to women that unless they have genetic risk factors, CPM will not improve their survival rates.