From the Guidelines
Mastectomy does decrease the risk of breast cancer recurrence, particularly in women with high-risk factors, with bilateral mastectomy reducing the risk by 90%–95%. Mastectomy, which involves surgical removal of the entire breast tissue, is an effective treatment that eliminates most breast tissue where cancer could potentially recur. For women with early-stage breast cancer, mastectomy typically reduces local recurrence rates to approximately 5-10% over 10 years 1. The procedure may be performed on one breast (unilateral) or both breasts (bilateral), with bilateral mastectomy providing additional risk reduction for women at high risk of developing cancer in the opposite breast. However, even after mastectomy, recurrence can still occur in the chest wall, regional lymph nodes, or as distant metastases. The recurrence risk varies based on individual factors including tumor size, lymph node involvement, tumor grade, hormone receptor status, and whether adjuvant treatments like chemotherapy, radiation, or hormone therapy are used after surgery.
Some key points to consider:
- Bilateral mastectomy can reduce the risk of breast cancer incidence and mortality by 90%–95% in women with high-risk factors, such as BRCA1 or BRCA2 gene mutations 1.
- For many women with early-stage breast cancer, breast-conserving surgery (lumpectomy) followed by radiation therapy offers similar overall survival rates to mastectomy while preserving the breast, though local recurrence rates may be slightly higher with this approach 1.
- The use of prophylactic mastectomy contralateral to a breast treated with lumpectomy is very strongly discouraged in all patients, except in specific cases where the risk of contralateral breast cancer is high 1.
- Recent studies have shown that radiation therapy after mastectomy can reduce locoregional recurrences, overall recurrences, and breast cancer mortality in women with certain high-risk factors, such as multiple positive nodes 1.
Overall, the decision to undergo mastectomy should be based on individual factors, including the patient's risk profile, tumor characteristics, and personal preferences, and should be made in consultation with a healthcare provider. The most recent and highest quality study supports the use of mastectomy as an effective treatment for reducing the risk of breast cancer recurrence, particularly in high-risk women 1.
From the Research
Mastectomy and Risk of Recurrence of Breast Cancer
- Mastectomy, the surgical removal of one or both breasts, is a procedure that can decrease the risk of recurrence of breast cancer in certain individuals, particularly those with high-risk gene mutations such as BRCA1 or BRCA2 2.
- The decision to undergo mastectomy for risk reduction is complex and highly personal, with factors such as prior history of breast cancer, history of other risk-reduction or noncancer-related surgeries, and age at presentation influencing the decision 3.
- Contralateral risk-reducing mastectomy, which involves removing the healthy breast, may be indicated for patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, but its benefit in moderate-to-low-risk populations is unproven 4.
- Studies have shown that skin-sparing mastectomy, which preserves the natural skin envelope of the breast, does not significantly increase the risk of local or systemic disease recurrence in patients with early breast cancer 5.
- For women without high-risk gene mutations, the evidence for mastectomy as a risk-reducing measure is less clear, and decisions should be made on a case-by-case basis, taking into account individual risk factors and quality of life measures 6.
Key Considerations
- The objectives of risk-reducing mastectomy include reducing the incidence of breast cancer, reducing mortality from breast cancer, and providing psychological benefits, while also considering cosmetic outcomes and quality of life issues 2.
- The surgical technique for mastectomy should aim to remove substantially all at-risk breast tissue, while balancing cancer risk reduction with cosmetic outcome 2.
- Patients considering mastectomy for risk reduction should be thoroughly evaluated and counseled, with a multidisciplinary team approach, to ensure that they are making informed decisions about their care 3, 6.