Contralateral prophylactic mastectomy
(for patients who have had breast cancer on one side)
Rationale
[edit | edit source]- Reduce the risk of contralateral breast cancer
- If no BRCA: about 0.4-1% per year cumulative risk over their lifetime
- If BRCA: 10-25% (but might be much higher)
- Ease of follow-up
- Reduce anxiety
- Desire for symmetry
Key discussion points:
[edit | edit source]- No survival benefit if high-risk conditions are not present
- Rationalise perceived vs actual risks
- Doesn't change the risk of current cancer or treatments required
- There are risks to CPM - 1 in 8 morbidity
- There are other options for risk reduction (surveillance, chemoprevention)
- Younger patients with higher risk profiles may be more suitable for the procedure
Technical factors:
[edit | edit source]- No known risk of spreading cancer from one breast to the other - recommended to do the 'cancer' breast first if doing both
- SLNB not recommended