Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

Abstract

The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.

Precise, Genotype-First Breast Cancer Prevention: Experience With Transferring Monogenic Findings From a Population Biobank to the Clinical Setting

“…This finding is in line with the previously reported 31% risk-reducing salpingooophorectomy uptake and no uptake of prophylactic mastectomy during follow-up among EstBB BRCA1/2 carriers (Leitsalu et al, 2021). It can be explained by the short follow-up period; cultural factors and traditions; the lack of availability of and reimbursement high-quality breast reconstruction, as well as the inability to consult doctors about such procedures; and several other factors (Scheepens et al, 2021). We did not directly examine these possible explanations for low preventive surgery uptake in this trial.…”

The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population

“…The increasing rate of bilateral mastectomy is consistent with recent trends of increasing contralateral prophylactic mastectomy. 16,19–21 Decreased access to surveillance imaging, socioeconomic factors, and cultural differences may further explain this observation, 8 and this finding is undergoing further study at our institution to determine other possible influences. Approximately half (52.6%) of all mastectomy patients underwent breast reconstruction, which is comparable to previous literature demonstrating a postmastectomy reconstruction rate of 40%.…”

The impact of coding germline variants on contralateral breast cancer risk and survival

“… 25 , 36 , 37 , 38 Assuming that mainly women known to be carriers of pathogenic variants in either BRCA1/2 or TP53 or women with known family history (from family or clinical genetic center-based studies) underwent a contralateral mastectomy, these would be a minor part of our study population and we do not expect their inclusion to substantially affect the results. Although the past decade has seen an increase in the number of women opting for a contralateral mastectomy without knowing their mutation status, 39 , 40 , 41 , 42 to the best of our knowledge most of this increase has been in North America. Most of our study population comes from European countries and only includes two USA studies and one study from Canada, which amounts to approximately 7% of the total study population.…”