Cirugía reductora de riesgo en el cáncer de mama

Abstract

ObjectiveTo conduct a literature review of contralateral prophylactic mastectomy in unilateral breast cancer as risk reducing surgery and its probable effect on survival. Material and methodWe performed a systematic search of the literature on prophylactic mastectomy by using the following keywords risk reducing surgery, breast cancer, incidence, complications, disease-free survival, overall survival, mortality due to breast cancer, and costs. ResultsThere is a general trend to increased use of contralateral prophylactic mastectomy to reduce the risk of contralateral breast cancer. The main factors influencing this process are young age, Caucasian race, early-stage breast cancer, estrogen receptor positivity, the use of magnetic resonance imaging at diagnosis, high educational level, access to immediate breast reconstruction, and family history of breast cancer and/or genetic testing for the BRCA1 and BRCA2 mutations. This surgery may have complications, which can lead to reoperation and/or delay adjuvant therapy and may also have a psychosocial impact, influencing body image and sexuality. Mastectomy may reduce the risk of contralateral breast cancer, favoring symmetry, but with no apparent survival benefit. Improvements in adjuvant treatments have improved survival in these patients with a lower proportion of contralateral breast cancers. Contralateral prophylactic mastectomy is clearly cost-effective in patients carrying the BRCA1/2 mutation. ConclusionProphylactic mastectomy appears to reduce the risk of contralateral breast cancer, although this procedure should be reconsidered because it is not free of complications. Realistic information on the intervention and the disease, as well as genetic counseling, are required for proper decision-making.