This year alone, hundreds of thousandsof women will hear the startling words, “you have breast cancer”. If you are one of them, it’s important to understand how to determine if you’re at high or average risk for getting cancer in your healthy breast, and what options mightbe best for you if surgery is needed.
“When first diagnosed with breast cancer, a common desire is to want to remove both breasts to be safe,” says Amit Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who also performs breast surgery. “While this may seem like a preventative measure, it’s not always prudent to remove the unaffected breast.”
Recently the American Society of Breast Surgeons cautioned against this ongoing trend of removing the healthy breast, known as contralateral prophylactic mastectomy (CPM), and determined that it’s unnecessary for the majority of individuals who are at average risk of developing cancer in their other breast.
“Removing the breast without cancer does not reduce the chance of a recurrence or cause the disease to spread,” explains Dr. Kharod. The risk of a local recurrence (the cancer coming back in the same place) and metastasis (when the breast cancer spreads) varies from patient to patient and depends on the type of breast cancer and treatment a person had. According to the Susan G. Komen Foundation, the risk of developing breast cancer in the healthy breast is just 0.1 to 0.6 percent per year for breast cancer survivors at average risk.
However, women with a known genetic risk for breast cancer — those who have tested positive for the BRCA1/2 gene or other genetic mutations — are considered to be at high risk and can lower their chances of developingbreast cancer in their healthy breast by having it removed preemptively.
How do you know if you’re ataverage risk? Your medical team might use a breast cancer risk assessment tool to calculate your individual risk, but you’re likely to be at average risk in the healthy breast if:
1. There is no suspicion of an inherited genetic link to your breast cancer;
2. You do not carry the BRCA1/2 gene;
3. You do not have a first-degree family member who has had breast cancer under the age of 50;
4. You never had radiation on the chest wall in childhood or adolescence.
If you determine that you are at average risk of developing breast cancer in your healthy breast over your lifetime, only surgery on your affected breast is recommended. Depending on your age, grade and type of breast cancer, your doctor will perform either a lumpectomy (partial mastectomy), a surgery that spares the breast with cancer by removing only the tumor and some neighboring tissue, or a mastectomy, the removal of the whole breast with cancer.
“The goal of the surgery is to remove the cancer,” says Dr. Kharod. To ensure that all the cancer is removed, in most cases women undergo additional therapies such as chemotherapy, radiation, and hormone therapy depending on their breast cancer diagnosis.
Knowing your risk is a helpful tool for making surgical decisions. For some women, other considerations like breast appearance and symmetry, as well as anxieties about future screenings, are also things to think about when deciding on the best overall surgical treatment for them.