Increasing contralateral mastectomy use at diagnosis: Surgical prevention of contralateral breast cancer

Abstract

Patients with unilateral breast cancer are at increased risk for developing contralateral breast cancer (CBC). The annual risk of clinically detected metachronous CBC is about 0.6%. Some patients choose contralateral prophylactic mastectomy (CPM) to prevent CBC. Recent studies reported that the CPM rates have markedly increased in recent years in the United States. The risk of CBC is reduced by about 95% after CPM. Because risk of systemic metastases often exceeds risk of CBC, most patients will not experience any survival benefit from CPM. Moreover, CPM is irreversible and not risk-free. Alternatives to CPM include surveillance with clinical breast examination, mammography, and possibly breast MRI. Endocrine therapy with tamoxifen or aromatase inhibitors significantly reduces risk of CBC and may be more acceptable than CPM for some patients.