Contralateral Prophylactic Mastectomy (CPM) Consensus Statement from The American Society of Breast Surgeons: Data on CPM Outcomes and Risks

Authors: Boughey, JC, Attai, DJ, Chen, SL, et al.

Source: Ann Surg Oncol (2016). doi:10.1245/s10434-016-5443-5

link.springer.com/article/10.1245/s10434-016-5443-5

Contralateral Prophylactic Mastectomy (CPM) is removing a breast that does not have breast cancer in a patient who has a breast that contains cancer removed. More women are choosing CPM and this trend has been questioned by physicians and the media. A panel of experts from The American Society of Breast Surgeons (ASBrS) investigated this by reviewing the medical literature, taking a poll from the members of the ASBrS and holding a meeting to discuss CPM. 

The experts found that:

• The “risk of contralateral breast cancer (CBC) for average-risk women with breast cancer is 0.1 to 0.6% per year.”
• CPM does not improve a patient’s survival, “with the possible exception of BRCA carriers.”
• There are 2 times the surgical complications with CPM as compared to a single mastectomy.
• “Bilateral reconstruction may provide improved cosmetic outcome.”

Their conclusions that have been adopted by the ASBrS are:

Patients who will benefit from CPM include:

• BRCA1 and BRCA2 genetic carriers 
• Patients with a significant family history but who have not had genetic testing
• Patients who had chest radiation before they were 30 years old

Patients who may benefit from CPM include:

• Non-BRCA gene carriers
• Patients with a strong family and who are BRCA negative and whose family does not have a BRCA carrier
• Patients whose breasts are extremely dense
• Patients whose breast cancer could not be detected by imaging
• Patients who are extremely anxious
• Patients who desire symmetry after breast reconstruction

Patients who should be discouraged from CPM:

• Average-risk woman with only one breast containing cancer
• Patients who have metastatic or advanced breast cancer
• Patients who have significant health concerns, like diabetes and obesity
• Patients who smoke
• Women who are BRCA negative whose family has BRCA gene carriers
• Men with breast cancer, including men who are BRCA gene carriers

“The consensus group agreed that CPM should be discouraged for an average-risk woman with unilateral breast cancer. However, patient’s values, goals and preferences should be included to optimize shared decision making when discussing CPM. The final decision whether or not to proceed with a CPM is a result of the balance between benefits and risks of CPM and patient preference.”