Cancer in One Breast Does Not Increase Recommendation for Double Mastectomy in Most Cases
You have breast cancer and you need treatment. In addition to having a mastectomy – removal of the breast with cancer – you are also worried about developing cancer in your other breast. You may be wondering if it makes sense to have the healthy breast removed as well.
Dr. Holly Mason, co-medical director of the Baystate Breast & Wellness Center and a breast cancer surgical oncologist, says there are several considerations.
“We have three goals for your treatment,” she explains. “Treat the breast cancer that you have. Minimize your risk for developing cancer in the other breast. Minimize your risk of having complications from surgery.”
Dr. Mason says the decision is a matter of balancing risks. “For a woman with breast cancer in one breast, the average risk of developing breast cancer in the other healthy breast is very small: 0.1-0.6% per year.
She adds, “Your long-term survival is not improved by removing the healthy breast, unless you have been found to have a gene mutation, such as the BRCA mutation.”
Dr. Mason says that removing the healthy breast will not:
- Improve your cure rate for the known cancer that you have.
- Lower the chance of the cancer you have of returning.
- Change the recommendations for additional treatment, such as chemotherapy or radiation, for the cancer that you have.
Further, there are risks to removing the healthy breast.
Doing so will:
- Double your risk of having a complication – a serious problem after surgery– which may include: bleeding, infection, chronic pain, and permanent numbness in the chest wall.
- Put you at risk for a delay in the treatments that you need for your known cancer, such as chemotherapy or radiation.
- Require you to have an increased number of surgeries.
- Make you lose the option to breast feed, should you ever desire to.
- Potentially affect your sense of physical, emotional and sexual well-being.
Dr. Mason says it’s important to remember that any medical treatment (anti-hormone therapy or chemotherapy) that you receive beyond removal of the breast with cancer will lower the risk of you developing cancer in the other breast. Even if you have the other breast removed, you will still require that additional treatment.
When Removal of the Healthy Breast Should be Considered
The specialists at the Baystate Regional Cancer Program follow the recommendations of the American Society of Breast Surgeons (ASBS), which say that removal of the healthy breast should be considered if:
- You have had genetic testing that showed the BRCA mutation.
- You have a strong family history, but you have not undergone genetic testing.
- You have a history of chest wall radiation called “mantle radiation” before the age of 30 (usually for Hodgkin’s Lymphoma).
Additional considerations may include:
- You have had genetic testing that showed you have a gene mutation that is not the BRCA gene mutation, but that still puts you at risk for breast cancer, such as the CHEK-2, PALB-2, p53, CDH-1 mutations.
- You have a strong family history for breast cancer, you had testing but you did NOT have the BRCA mutation, but no one in your family has tested positive for the BRCA mutation.
Who Should Not Have a Healthy Breast Removed
Dr. Mason says it’s understandable that some people experience tremendous anxiety when faced with a breast cancer diagnosis, but that alone should not be a driving factor in removal of the healthy breast.
Some patients also mistakenly believe that a double mastectomy will allow a more similar appearance between the breasts after reconstruction, but that also should not be the only driving factor in the decision.
Removal of the healthy breast is also not recommended if:
- You have cancer in one breast and are not at any increased risk to develop breast cancer in the other breast from having a strong family history or a gene mutation for breast cancer.
- You have breast cancer that has been called “locally advanced,” ”inflammatory,” or you have cancer that has spread to your lymph nodes.
- You are at high risk for complications from surgery (for example, you are obese, smoke, have diabetes, or need to take steroids).
- You underwent genetic testing and were NOT found to have a gene mutation (the BRCA mutation), but someone in your family is known to have the BRCA mutation. Being negative for this test means that you are considered “average risk” for cancer in the other breast.
- You are a man and have breast cancer.
Overall, Dr. Mason states that the decision to have a double mastectomy should be made only after a careful discussion with your surgeon concerning the risks and benefits of the procedure to ensure that you are informed and can make the decision that is right for you.