What is the role of contralateral prophylactic mastectomy (CPM) in the surgical treatment of breast cancer?

Updated: Feb 13, 2019
  • Author: Mary Jo Wright, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

Patients diagnosed with breast cancer who are not known carriers of a deleterious BRCA mutation are predicted to have a 0.7% annual risk of contralateral breast cancer. Patients who are known BRCA mutation carriers have a 3% annual risk of a contralateral breast cancer.

The decision for contralateral prophylactic mastectomy (CPM) is a personal decision for the patient and is impacted by cancer stage, patient’s desire for symmetry, comorbidities, histologic risk factors, family history, potential difficult surveillance, and degree of risk aversion. Patients with locally advanced breast cancers should be discouraged from a contralateral prophylactic mastectomy, as potential surgical complications could compromise their oncologic treatments. Mastopexy and reduction mammoplasty for the contralateral breast are potential alternatives to contralateral prophylactic mastectomy as symmetry procedures.

One study sought to identify factors predictive of high-risk lesions and/or occult contralateral breast cancer in women undergoing CPM for newly diagnosed breast cancer. The study found that while the diagnosis of multifocality/multicentricity invasive index cancer was the only factor associated with occult malignancy, patient age and progesterone receptor positivity of the index cancer were associated with finding either malignancy or a high-risk lesion in the CPM. The findings suggest that because lack of standardized definitions and differences in pathologic evaluation may limit the use of this data in the preoperative setting, the use of CPM in an average-risk woman with newly diagnosed breast cancer is not supported. [18]


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