Young women with breast cancer often overestimate their risk of developing cancer in the other breast—and also tend to overestimate the protective effect of removing the second breast, according to the results of a study published in the Annals of Internal Medicine.
Approximately 200,000 women are diagnosed with breast cancer every year in the United States alone. Some women who have been diagnosed with breast cancer will eventually develop a second breast cancer in the opposite breast. This is referred to as a contralateral breast cancer. In order to mitigate the risk of developing contralateral breast cancer, some women undergo contralateral prophylactic mastectomy (CPM)—preventive removal of the healthy breast. In fact, data suggests that more and more women are making this choice—and the trend is pronounced among younger women. The question remains, though, whether CPM is necessary or beneficial.
Women who have had breast cancer are at a slightly higher risk of developing cancer in the second breast, especially if they have a genetic mutation. However, among women without genetic mutations, the chance of developing cancer in the second breast is about 2 to 4 percent over five years. What’s more—evidence shows that removing the cancer-free breast does not improve survival rates.
To examine perceptions of risk, researchers conducted a cross-sectional survey that included 123 women who had opted for double mastectomy after a breast cancer diagnosis in one breast. All of the women were between the ages of 26 and 40 and all had opted for CPM. The results of the survey found that almost all of the women said a desire to extend their life was a very important part of their decision to undergo CPM. What’s more—the survey found that many of the women “vastly overestimated” their risk of developing a secondary cancer, with many believing that the risk was 10 percent over five years rather than 2 to 4 percent. Women with BRCA1 or BRCA2 mutations more accurately perceived their risk for contralateral breast cancer, whereas women without a mutation substantially overestimated the risk.
The researchers concluded that despite knowing that CPM does not improve survival, many women are opting to undergo the procedure in an effort to extend their life. Indeed, some women may benefit from CPM, but it’s important to make the decision based on the correct information.
It’s important to note that CPM can reduce the risk of developing a secondary breast cancer; however, the real concern lies with the risk of developing metastatic disease as a result of the original cancer. CPM does nothing to prevent that risk.
The researchers suggest that improved doctor-patient communication is warranted in order to make the best decision regarding CPM.
Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: A cross-sectional survey. Annals of Internal Medicine. 2013; 159(6): 373-381.