Lots of medical meetings are held at this time of year, which means lots of media coverage of new breast cancer research. Whenever you hear about a new study, keep in mind that any results that are presented but not published have not passed the critical peer review process and are considered preliminary.

This will undoubtedly be the case with many of the stories coming out of the 2012 San Antonio Breast Cancer Symposium, which begins tomorrow. I won’t be attending this year, as I am still recovering from my transplant. But I will be using my blog to keep you abreast (pun intended) of what emerges from the meeting and help you separate the important news from the hype.

Right now, I want to address two recent studies that illustrate women’s concerns about their other, healthy breast after a cancer diagnosis. One study looked at the risk of getting breast cancer in the other breast; the other explored women’s understanding of the benefits of a contralateral mastectomy.

The first study, about breast cancer risk, was presented in September at the American Society of Clinical Oncology Breast Cancer Symposium by Courtney Vito, a surgical oncologist at City of Hope in Duarte, Calif. Vito and her research team used a Surveillance, Epidemiology and End Results (SEER) database to look at second cancers that occurred in 109,411 women who had been diagnosed with breast cancer in one breast between 1998 and 2006. All of the patients had a mastectomy, with 10 percent also choosing to have a contralateral prophylactic mastectomy (preventative removal of the healthy breast).

The standard teaching has been that the risk of a second breast cancer is 1 percent per year. But Vito’s study found that the risk of a second breast cancer is actually lower: less than 1 percent over 51 months (four years). Specifically, a second cancer was diagnosed in only 867 women, the majority of whom (66.2%) had their cancer detected at an early stage. The women with the highest risk of developing a cancer in the opposite breast were those who were known to have a BRCA1 or BRCA2 genetic mutation.

Why is the risk of a second cancer even lower than we had believed? It may be, in part, because many of the drugs used to treat the first cancer—hormonal therapies and even chemotherapy—can reduce the risk of cancer occurring in the other breast. There also could be other factors that weren’t properly accounted for previously. What is clear is that we need to look more closely at the increasingly widespread use of contralateral prophylactic mastectomy—especially since the risk of complications from this surgery can be as high as 20 percent.

Why do women choose to have a double mastectomy? The second study, which was presented at the Quality Care Symposium in November by Sarah T. Hawley, an associate professor of general medicine at the University of Michigan in Ann Arbor, explored this exact question. She found that 90 percent of women with early stage breast cancer underwent the surgery because they were “very worried” about recurrence.

Some of these women may have been very worried because their risk of recurrence was not explained clearly. A woman’s prognosis is determined by the original cancer—its molecular type and its likelihood to spread to another organs—and how it is treated. Getting a second cancer in the other breast is unlikely to change this outcome. It’s also likely that after their first experience some of these women didn’t want to continue to  have mammograms and MRI’s and preferred to have their healthy breast removed.  In addition, plastic surgeons prefer doing a bilateral mastectomy because it makes it easier to do reconstruction, so that could have played into their decision.

I would never argue with any women about her personal choice. However, I do think it is important for us to realize that it is not what occurs in the breast that causes women to die of breast cancer but rather what happens when the cancer cells spread to other parts of the body. And from that perspective, it’s the systemic therapy, such as chemotherapy, hormone therapy, and Herceptin, that has been found to improve survival—much more than having the other breast removed.

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23 Responses to Is The Other Breast at Risk?

  1. That’s very interesting news. I know that many women are filled with dread after the initial diagnosis, and see the removal of the second breast as a step toward eliminating that worry of recurrence. Maybe more does need to be explained about the statistics. That being said, if the only way a woman can find peace of mind is to have the bilateral surgery . . . then that should also be a big factor worth considering. ~Catherine

  2. So Glad I Did says:

    I chose to have a bilateral after a biopsy showing ILC. I am SO glad I did, as I had cancer in both breasts. An MRI did not pick it up in either breast. It saved my life.

  3. flat-chested says:

    While the idea of having to endure repeated mammograms on my healthy breast and the fear of potential recurrence did play a role in my thinking, my main reason for having my contralateral breast removed was cosmetic. What does one do with just one breast? It poses problems. A substantial percentage of women who have reconstruction are unhappy with the result within a few years or need repeated surgeries. I couldn’t stomach the idea of having a fake breast, and wearing a bra with a falsie also did not appeal. While I’m not happy about the loss of my breasts, in practical terms it was the best solution. I look normal and will never wear a bra or have a mammogram again. Nothing sags, bounces, or sticks out. It’s freeing, in a number of ways.

  4. Emily says:

    I am grateful that my own doctors, Susan Troyan and Ann Partridge, helped me to understand this when I was first diagnosed two years ago — and yet it’s always reassuring to read of new research that continues to support my decision. I’m looking forward to (single) DIEP flap reconstruction in March!

  5. Surviving in Georgia says:

    I chose to have a bilateral mastectomy for all of the above reasons. Mostly, I did not want to live with the fear of it coming back in any way shape or form in my other breast. My cancer was very aggressive – one day it wasn’t there and literally, the next, it was – to the tune of 5.7 cm with lymph node involvement. Perhaps I reacted out of fear but my gut told me to throw everything at this including the kitchen sink. Am I thrilled with the results, not really. Radiation does a number on your reconstruction. That being said, the peace of mind is priceless as you never know if your are going to be one of those 867 people who had a recurrance.

  6. Ann says:

    Because my cancer was detected by the merest of coincidence (happened to see tiny drop of fluid from nipple the split second before it disappeared) and because mammogram just a few months prior had picked up nothing I walked around thinking of my other healthy breast as the anvil over the Coyote’s head….no way of knowing if or when the Roadrunner’s going to beep beep past and them BAM! The uncertainty invaded everything. Dixie Mills (who was relocating) understood, steered me toward Melinda Molin, and my prophylactic mastectomy was the best thing I could’ve done.

  7. Kim Groglio says:

    I too chose a bilateral mastectomy as I not only had multi-focal (many) tumors in the first breast – which I detected myself and did not show up on mammograms or conclusively on ultrasound which were likely growing for quite awhile undetected, but also because my mother, my younger sister and my paternal grandmother also had breast cancer. We have all tested negative for the BRAC mutations, so there is a big unknown for us. I have never regretted my decision as the pathology reports did in fact find cancer in the second breast, which did not show up on MRIs or any other detection method available at this time. I would not have wanted to go through the surgery, chemo, radiation (actually, I believe I have already had the maximum due to unclear margins and cancer on my chest wall & lymph nodes) again had I chosen to keep the remaining breast only to have the cancer there detected later.

  8. Lori McLean says:

    When my mother dies of breast cancer (bilateral) in 1996, after her sister had died of the same in 1981, I decided right then and there that when my time came I would opt for bilateral mastectomies, period. In 2005 I did just that after a diagnosis of triple negative breast cancer. I was stage 1 but I knew that I could not “wait for the anvil to drop” as Ann so perfectly put it! No regrets. Only wish I had not bothered with the reconstruction.

  9. Marsha says:

    My contralateral was a year after my Stage 0 [DCIS] mastectomy. Stage 0 mastectomy due to the size of the area; no chemo; no radiation; no Herceptin, or other drugs. So why? Definitely the ticking time bomb: inverted nipple, nipple discharge, mammogram callbacks [a FULL MONTH after the mammogram]. Biopsies showed: both ALH and ADH [pre-cancer]. I am very glad I made the decision and when I made it. I choose no reconstruction after reading about all the options and am equally happy with that decision, as well.

  10. Marlyne Rohan says:

    In my case, I had large breasts, and my chiropractor told me that the unevenness of just removing one breast would increase my scoliosis. This, and the difficulty of dealing with a prosthesis made my decision for me, and I removed both breasts. As it happened, my “healthy” breast had many calcifications and lobular cancer in situ and ductal cancer in situ that had not been detected by digital mammogram or MRI. I am happy as a “B-flat”, and I am grateful for my decision.

  11. Jen says:

    I did not want to have one breast removed, much less both. Reconstruction was the only option for me and so glad I went through with it. In hindsight, I should have had less surgery, rather than more. As I suspected, I was overdiagnosed.

    Personally, I would never, EVER remove a good, decent body part. I am extremely happy with my decision and the only thing I would have done differently would have been to listen to my gut and have a less involved surgery to begin with.

  12. Margaret Andrews says:

    I agree so much with flat chested as that is what I am. I had breast cancer in 1999, Stage 2b with node involvement. I went around lopsided for several years. My mother had breast cancer and then 20 years later it reappeared in her other breast and she underwent a second mastectomy. The in 2007, three years later, my mom died with tumors appearing on her shoulder and head, a biopsy revealed that her breast cancer had returned. I had continued to get mammograms, with several biopsies and magnification views each time with the worry that the cancer had returned for me. Three months after she died I decided that my other breast would be removed. No cancer found, but I am at peace and flat chested. I never liked wearing a bra and now I am free.

  13. Anne-Marie says:

    I was diagnosed with 3 different types of breast cancer in one breast – one of which was tubulo-lobular – and had a mastectomy. Once I was told there was a very high risk that this particular type would eventually start up on the other side and it’s not usually screen-detectable (by mammogram or ultrasound) I elected to have that breast off too rather than worry about it for years to come!

  14. June Warfield says:

    It might just be me, but I feel a little uncomfortable with the term “falsie”. When I was growing up (I’m now 64), “nice” girls did not use falsies (I have an excessively “prim and proper” background that I can’t seem to shed!). The word still has negative connotations for me. I am perfectly comfortable referring to my manufactured breast as a “prosthesis”. Unfortunately, my initial breast reconstruction attempt was unsuccessful due to infection, and a prosthesis is my only non-surgical option.

  15. Sharon says:

    I had breast cancer on the right breast in 2006. 4 years and 10 months I was told that the Left Breast had to be removed. I had a Mammogram every 6 months on both breasts. Each time the would say we are watching the left breast . but it seems to look OK. I took Arimidex , I guess it only protects the Right Breast.
    I am think I may take the test to see if I carry the BRCA1/BRCA2.

  16. Karen Bayne says:

    I was a good girl and had gotten a mammogram every year since turning 40. Because I had extremely dense breast tissue and was premenopausal, my cancer never showed on a mammogram: not the one taken 8 months prior to my diagnosis, nor the one taken the day after I found the 3.5 cm lump very close to the skin. I wasn’t so worried about recurrence, which I felt was out of my control; I was worried about undetectable recurrence. Had my lump been deep within my breast tissue, I am sure I would not be here today. If I’d originally been told to do ultrasounds instead of mammograms because of my extremely dense tissue, perhaps I would have reconsidered my bilateral mastectomy. Msybe thr cancer would have been caught earlier. But with two young children at home, medicine didn’t seem to offer me any protection. I felt I had no choice but to take matters into my own hands. I got lymphedema, which has made my life pretty bad (I was an athlete), but I do not regret my choice to have the other breast removed.

  17. Vera says:

    You should be doing research on the statistices on women that decided to do homeopathic treatments. As a three time breast cancer survivor I have not wanted to take the medications recommended by my oncologists due to the side effects. After #3 I decided I had to find out why my body was not healthy. It has been an amazing journey but for once I feel can beet this so it won’t come back. Please give women all the facts on the options not just cutting, chemo &/or radiation.

  18. Ann403 says:

    I was diagnosed with synchronous bilateral breast cancer this spring. The first cancer showed up on a routine mammogram and a follow up precautionary MRI a week later revealed the tumor in the other breast. Is there any data about risk of recurrence when the cancers synchronous? Is the risk greater? I’ve been told that this occurs in 2-4% of women, depending on how synchronous is defined.

  19. Nina Goldstein says:

    Does this mean that if we did not have hormonal therapies or chemotherapy our risks are higher?

  20. DSLRF says:

    Nina – Yes the risk is higher with only surgery but still quite low and not enough to warrant preventative surgery in women who are not BRCA carriers.

  21. Marilyn says:

    I fully agree with Vera. It’s good to hear, and not often enough, that there are other ‘natural’ treatments for breast cancer that work. Unfortunately, these natural treatments do not get the same ‘press’ as the pharmaceutically backed chemo and hormonal treatments. As Vera said: You should be doing research on the statistices on women that decided to do homeopathic treatments. As a three time breast cancer survivor I have not wanted to take the medications recommended by my oncologists due to the side effects. After #3 I decided I had to find out why my body was not healthy. It has been an amazing journey but for once I feel can beet this so it won’t come back. Please give women all the facts on the options not just cutting, chemo &/or radiation.

  22. Luna says:

    Breasts have never meant that much to me. They always seemed to get in the way of being active. Never found comfortable bras. I have dense breasts, and a 3cm With a unilateral mx, neuropathic pain, scarring, and trunkal LE it’s even worse. Wearing a bra is bad for my trunkal LE. My CA was ILC. ILC has a higher chance of showing up in the contralateral breast than other BC types. I plan a prophy MX and it will be so freeing to be done with bras and horrible uncomfortable garments and foobs.

    Reconstruction with cannibalizing other perfectly good body parts to fake a breast mound with no feeling? 8-hr surgeries or longer? Implants, which they have to put in after cutting your pectorals? Ugh.

    None of the options are idea. But I love the idea of being done with non-essential body parts which are uncomfortable and for me, have a 20-30% chance of trying to kill me.

    Women, feel free to do what you want. You have to wear your body.

  23. Sue says:

    I feel bad for Luna with all of her complications. I too have neuropathic pain, which makes it painful to wear a bra. I have mentioned to my pain management physician, and to my surgeon, who are both female, my thoughts that it would be better to have a simple mastectomy on my unaffected side and be flat. My surgeon asked me to clarify what I had said, she apparently could not believe what I had said; she then told me she would recommend I not have the other breast removed as I might end up with pain there also. My pain management doctor, basicly looked at me and laughed and told me she would suggest not going through any major surgery unless absolutely necessary. It is so good to hear your thoughts and those of Margaret. Margaret, I have never liked wearing a bra either and I would so much like to be free! I so much hate being lopsided. I do think I may resume my thoughts of having a mastectomy on my “good” side. My highly sensitive tissue on my mastectomy side feels soo much better when I wear a nice soft camisole, instead of a bra. Heck, I might even be able to get off of the MS Contin, Vicodan, Lyrica, and multiple topical meds!!

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