American Society of Breast Surgeons, 12th Annual Meeting, Washington DC, April/May 2011

The American Society of Breast Surgeons is the primary leadership organization for breast surgeons in the United States. The Society’s Annual Meeting is the only medical meeting dedicated exclusively to the latest issues affecting surgeons who treat breast disease, from diagnosis and staging to treatment planning and ongoing management. The Society hosts this meeting to provide the surgical community with a forum to discuss and present the newest techniques in imaging, biopsy, and surgery. Jane O’Brien joined 1,200 breast surgeons who assembled for the Society’s 12th Annual Meeting in Washington DC April 27- May 1 2011 to discuss the latest issues affecting surgeons who treat breast disease.

One topic addressed was the issue of contralateral prophylactic mastectomy. Among patients with unilateral breast cancer, without a BRCA mutation, the cumulative 10-year risk of contralateral breast cancer is less than 10%. Despite this relatively small risk, several studies have demonstrated that the rate of contralateral prophylactic mastectomy (CPM) has markedly increased in recent years. At the time of surgical evaluation, women with unilateral breast cancer grossly over-estimate their risk of contralateral breast cancer, according to a study presented which identifyied a mean estimated 10-year risk of contralateral breast cancer of 32.6% among women with newly diagnosed with breast cancer. Somewhat unexpectedly in this study, CPM rates were not significantly associated with perceived risk of contralateral breast cancer.

Pleasingly, according to another study presented by researchers at Mayo Clinic, Rochester, Minn. ninety percent of breast cancer patients who elected to have a contralateral prophylactic mastectomy (removal of the second healthy breast) to minimize risk of a second cancer remained satisfied with their decision 20 years later. Patients describing the positive impact of their choice in their own words commented: “I don’t seem to worry about breast cancer now…” “By having a prophylactic mastectomy, my fears (many) were erased, not 100 percent, but close to it.” “I didn’t want to be worrying and thinking about it (cancer in the other breast)…”
Noting that prophylactic mastectomy rates have been steadily increasing, researcher Dr Judy Boughey believes that knowing few women regret their decisions should help reassure those facing this difficult choice today. However, she advised that all women obviously need to consider such a decision carefully and to balance the negative consequences of mastectomy with their risk of cancer recurrence and need to achieve peace-of-mind.