Not All Breast Cancer Patients Need Double Mastectomies: Study
Seattle – Scientists have developed several risk factors that will predict who would benefit from preventive mastectomy.
The number of women choosing to have preventive mastectomies has doubled since 1998 and 2003, reports AHN.
According to researchers at the University of Texas M.D. Cancer Center, many of these women are having mastectomies because of their own fears — not because of a doctors recommendation.
“We’ve always known contralateral breast cancer risk is not the same for all women and it is unnecessary to perform preventive mastectomies routinely,” Dr. Kelly Hunt, a professor at M.D. Anderson, said in a statement. “As we begin to clarify the specific risk factors, the number of women undergoing [preventive mastectomies] may decrease and those with a low to moderate-risk may be more open to less extreme options for risk reduction, such as hormonal therapy and newer agents for prevention of breast cancer.”
To begin to classify such risk factors, researchers reviewed the cases of 542 women with breast cancer only in one breast who received CPM to remove the second breast at M. D. Anderson from January 2000 to April 2007. Out of this group, 435 patients had no abnormal pathology identified in the opposite breast, 25 patients had contralateral breast cancer identified at surgery, and 82 patients had abnormal cells (atypical ductal hyperplasia, atypical lobular hyperplasia and lobular carcinoma in situ) that indicate a moderate to high-risk for breast cancer development in the contralateral breast found at the time of surgery.
Further analysis of the patients with contralateral breast cancer revealed that a five-year Gail risk of 1.67 percent or greater; an invasive lobular histology; and multiple tumors in the original breast were all strong predictors for contralateral breast cancer. Patient race, estrogen receptor status and progesterone receptor status were not associated with increased risk.
“We went from having very little information on the benefit of this procedure for individual patients to identifying three independent and significant risk factors,” Hunt said. “Each provides valuable insight into how likely a woman is to develop the disease in her other breast and enables physicians to make an educated recommendation if a patient will potentially benefit from CPM.”
The study will be published in the March 1, 2009 issue of Cancer.