Posted on March 31st, 2009 by
The rate of contralateral prophylactic mastectomy (CPM) among women with ductal carcinoma in situ (DCIS) has drastically increased in the United States in recent years—by as much as 188%, according to the results of a study published in the Journal of Clinical Oncology.1
Ductal carcinoma in situ is the earliest stage of breast cancer, during which the cancer is small and confined to an area within a duct of the breast. Previously, DCIS was often considered a “pre-cancerous” condition that had the potential to turn into cancer. Now, however, DCIS is largely accepted as an early stage of breast cancer and is treated accordingly.
Depending upon the size and aggressiveness of DCIS, patients may undergo surgery in addition to radiation therapy or hormone therapy. Some patients opt for complete removal of the breast affected by DCIS (mastectomy), while others choose the surgical removal of DCIS and surrounding tissue (breast-conserving therapy).
Women with DCIS in one breast (unilateral) have an increased risk of developing either invasive cancer or DCIS in the other breast (contralateral). This risk builds over time and becomes clinically relevant. As a result, some women opt to have the contralateral breast removed (CPM).
Researchers used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the rates of CPM in women diagnosed with unilateral DCIS between 1998 and 2005. The study included 51,030 patients with DCIS, 2,072 of whom chose CPM. The researchers found that the CPM rate was 13.5% for women undergoing mastectomy and 4.1% for all surgically treated patients (including those who opted for breast-conserving surgery). Among the women who opted for mastectomy to treat their DCIS, the CPM rate increased by 188% from 1998 to 2005; when including women who opted for breast-conserving surgery, the increase in the rate of CPM during the same time period was still quite high at 148%.
The researchers concluded: “Despite having a low breast cancer mortality rate, women with DCIS are increasingly undergoing CPM.” While CPM does almost eliminate the risk of contralateral breast cancer; however, it is unclear how CPM impacts long-term breast cancer survival rates. This is a complicated issue and future studies will likely continue to focus on the risks and benefits of this growing trend.
1 Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. Journal of Clinical Oncology. 2009; 27: 1362-1367.
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