Abstract
BackgroundRates of contralateral risk-reducing mastectomy (CRRM) are rising, despite a decreasing global incidence of contralateral breast cancer. Reasons for requesting this procedure are complex, and we have previously shown a variable practice amongst breast and plastic surgeons in England. We propose a protocol, based on a published systematic review, a national UK survey and the Manchester experience of CRRM.MethodsWe reviewed the literature for risk factors for contralateral breast cancer and have devised a 5-step process that includes history taking, calculating contralateral breast cancer risk, cooling off period/counselling, multi-disciplinary assessment and consent. Members of the multi-disciplinary team included the breast surgeon, plastic surgeon and geneticist, who formulated guidelines.ResultsA simple formula to calculate the life-time risk of contralateral breast cancer has been devised. This allows stratification of breast cancer patients into different risk-groups: low, above average, moderate and high risk. Recommendations vary according to different risk groups.ConclusionThese guidelines are a useful tool for clinicians counselling women requesting CRRM. Risk assessment is mandatory in this group of patients, and our formula allows evidence-based recommendations to be made.
Highlights
Rates of contralateral risk-reducing mastectomy (CRRM) are rising, despite a decreasing global incidence of contralateral breast cancer
The last decade has seen a marked increase in the numbers of women requesting contralateral risk-reducing mastectomy (CRRM) following a diagnosis of unilateral breast cancer [1]
This is despite a decreasing incidence globally of contralateral breast cancer (CBC) as a result of successful adjuvant therapies [2]
Summary
Rates of contralateral risk-reducing mastectomy (CRRM) are rising, despite a decreasing global incidence of contralateral breast cancer. Reasons for requesting this procedure are complex, and we have previously shown a variable practice amongst breast and plastic surgeons in England. The last decade has seen a marked increase in the numbers of women requesting contralateral risk-reducing mastectomy (CRRM) following a diagnosis of unilateral breast cancer [1]. This is despite a decreasing incidence globally of contralateral breast cancer (CBC) as a result of successful adjuvant therapies [2]. For the majority of women with no known mutation, there appears to be little if any survival advantage to CRRM [5]
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