Management of the contralateral breast in women with breast cancer.

Abstract

Abstract Abstract #MS1-2 Patients with unilateral breast cancer are at increased risk for developing a second cancer in the contralateral breast. The annual risk of clinically detected metachronous contralateral breast cancer is about 0.7% Some women choose contralateral prophylactic mastectomy (CPM) to prevent cancer in the contralateral breast. A recently published study found that the use of CPM increased by 150% from 1998 to 2003 in the United States. Several studies have demonstrated that CPM significantly decreases the occurrence of contralateral breast cancer; the risk reduction is about 97%. Since the risk of systemic metastases often exceeds the risk of contralateral breast cancer, most patients will not experience any survival benefit from CPM. Moreover, CPM is not risk free, and patients may need to undergo additional surgical procedures, especially if reconstruction is performed. Nevertheless, most patients are satisfied with their decision to undergo CPM. Alternatives to CPM include close surveillance with clinical breast examination, mammography, and possibly breast magnetic resonance imaging. Endocrine therapy with tamoxifen or aromatase inhibitors significantly reduces the risk of contralateral breast cancer and may be more acceptable than CPM for some patients. Ovarian ablation and cytotoxic chemotherapy also reduce the risk of contralateral breast cancer. For women with unilateral breast cancer, management of the normal contralateral breast is complex. Future prospective studies are critically needed to evaluate the decision-making processes leading to CPM. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr MS1-2.