What are the ASBrS recommendations for contralateral prophylactic mastectomy (CPM) in the treatment of breast cancer?

Updated: Dec 27, 2019
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

A consensus statement from the American Society of Breast Surgeons (ASBrS) recommends that women with unilateral breast cancer who are at average risk should be discouraged from undergoing a contralateral prophylactic mastectomy (CPM), because most of those women, with the possible exception of BRCA carriers, will not obtain a survival benefit, and CPM doubles the risk of surgical complications. [170]

However, the ASBrS advises that the final decision whether or not to proceed with contralateral prophylactic mastectomy   is a result of the balance between benefits and risks of CPM and patient preference.

The ASBrS concluded that CPM should be considered for patients with any of the following significant risk factors for contralateral breast cancer:

  • BRCA1/2 mutations
  • Strong family history (in patient who have not undergone genetic testing)
  • Mantle chest radiation before age 30 years

The ASMBrS suggests that CPM can be considered for women with factors that place them at lower risk. These include women who are carriers of a non-BRCA gene (eg, CHEK-2, PALB2, p53, CDH1) and those with a strong family history of breast cancer but who are themselves BRCA negative and have no family member with known BRCA.

Other reasons for considering CPM, according to the ASMBrS, include the following:

  • To limit contralateral breast surveillance (dense breasts, failed surveillance, recall fatigue)
  • To improve reconstructed breast symmetry
  • To manage risk aversion
  • To manage extreme anxiety (although that may be better managed through psychological support strategies)

The ASMBrS recommends discouraging CPM not only in average-risk women with unilateral breast cancer, but in those with any of the following:

  • Advanced index cancer (eg, inflammatory breast cancer, T4 or N3 disease, stage IV disease)
  • High risk for surgical complications (eg, due to comorbidities such obesity, smoking, diabetes)
  • Negative BRCA test results, despite a family history of BRCA carriage

Finally, the ASMBrS recommends against CPM in men with breast cancer, even if they are BRCA carriers.


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