Contralateral Prophylactic
Mastectomy: A Narrative Review of the Evidence and Acceptability
by Josien C.C. Scheepens, Laura van ’t Veer, Laura Esserman,
Jeff Belkora, Rita A. Mukhtar
The Breast: February
10, 2021
The uptake of contralateral prophylactic mastectomy (CPM)
has increased steadily over the last twenty years in women of all age groups
and breast cancer stages. Since contralateral breast cancer is relatively rare
and the breast cancer guidelines only recommend CPM in a small subset of
patients with breast cancer, the drivers of this trend are unknown. This review
aims to evaluate the evidence for and acceptability of CPM, data on patient
rationales for choosing CPM, and some of the factors that might impact patient
preferences. Based on the evidence, future recommendations will be provided.
First, data on contralateral breast cancer risk and CPM rates and trends are
addressed. After that, the evidence is structured around four main patient
rationales for CPM formulated as questions that patients might ask their
surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of
contralateral breast cancer? Can I avoid future screening with CPM? Will I have
better breast symmetry after CPM? Also, three different guidelines regarding
CPM will be reviewed. Studies indicate a large gap between patient preferences
for radical risk reduction with CPM and the current approaches recommended by
important guidelines. We suggest a strategy including shared decision-making to
enhance surgeons’ communication with patients about contralateral breast cancer
and treatment options, to empower patients in order to optimize the use of CPM
incorporating accurate risk assessment and individual patient preferences.
