(Reuters Health) - Half of women with cancer in one breast - but no gene mutations that increase their risk - are interested in removing their healthy breast to avoid a second cancer there, a small survey finds.
Women with less cancer knowledge and greater worry about developing a new tumor were most likely to want the preventive removal of the healthy breast. But after talking to their surgeons, only 10 percent went ahead with the procedure.
“There have been numerous public figures that have talked about their experiences with prophylactic surgery,” said lead author Patricia A. Parker, a behavioral researcher at Memorial Sloan Kettering Cancer Center in New York.
“It is important for women to know that their risk factors for getting a cancer in the other breast may not be the same as these women and that the chances of a recurrence of the primary breast cancer are more likely than developing a new cancer in the other breast,” Parker told Reuters Health by email.
“Prophylactic mastectomy does not reduce the possibility of recurrence from the original breast cancer,” she said.
Parker and coauthors at The University of Texas MD Anderson Cancer Center in Houston, Texas, surveyed 117 women before their first consultation with a surgeon at Anderson. All the women had been diagnosed with early stage cancer in one breast and genetic screening showed no high-risk gene mutations, such as the inherited BRCA1 mutation known to increase the likelihood of developing breast cancer.
The survey prior to the surgical consultation asked questions to gauge the women’s knowledge and interest in prophylactic removal of the second, healthy breast.
After their visit, the women as well as their surgeons completed questionnaires about how much this option had been discussed. The women rated how likely they thought they were to have this surgery, and surgeons rated how appropriate the surgery would be.
On the first set of questionnaires, half of women were moderately to extremely interested in prophylactic mastectomy. More than 80 percent of these women did not go on to have the healthy breast removed during primary cancer surgery, however.
After the first visit, surgeons reported that they had discussed this option moderately to extensively in a third of visits, and not at all in 45 percent of visits.
The women whose questionnaires showed they had less cancer knowledge and greater worry tended to be more interested in prophylactic mastectomy, and those who were more worried were more likely to ultimately have the procedure.
After their visit, surgeons and women generally agreed on whether or not the procedure would be appropriate, as reported in the Annals of Surgery.
“A lot of patients are thinking about this before even talking to a surgeon,” said Dr. Todd M. Tuttle, a surgeon at the University of Minnesota in Minneapolis who was not part of the new study.
The surgeons seemed to do a good job of informing the patients of the risks and benefits since only 10 percent went on to have the surgery, Tuttle told Reuters Health.
“The best source of information to understand the characteristics of a woman’s particular cancer and whether prophylactic mastectomy may be a good choice for her is her healthcare team,” Parker said.
Mutations in the BRCA 1 or BRCA2 genes account for 5 to 10 percent of breast cancers, and increase the risk of cancer developing later in the opposite breast
But recent research finds that for women with early stage breast cancer and without the high-risk mutations, prophylactic mastectomy of the healthy breast may not confer any meaningful survival benefit.
Based on current evidence, the risk of an extra surgery to remove the healthy breast outweighs the potential benefit in preventing cancer in that breast in the future for women with sporadic cancer and no BRCA mutation, Parker said.
“For women who are not at high risk, the risk of developing another breast cancer is very small, especially if they receive adjuvant chemotherapy or hormone therapy as part of their treatment,” she said.
But prophylactic mastectomy is a very personal choice and only consultation between a woman and her healthcare team can determine what is the best choice, she said.
“If you’re thinking about having the other breast removed, you want to ask, what’s the risk of me actually getting cancer in that breast, is there a survival benefit, could there be early complications, late complications, insurance issues, payment issues, time off work issues,” Tuttle said.
“It’s important to not only talk about it but make sure you’re questions are getting answered,” he added.
SOURCE: bit.ly/1HeSs3X Annals of Surgery, online March 27, 2015.