Sandy Gladding, MD, is chair of the Surgery Department at Banner Estrella Medical Center,
Question: I’ve read about women with breast cancer in one breast choosing to have both removed. Why would anyone do that?
Answer: For women who have breast cancer in one breast, the risk of having a primary breast cancer in the opposite breast is about one percent per year. For women younger than 55 or those who have invasive lobular breast cancer in their breast (cancer growing in the cells that line the lobules of the breast), that risk increases to about 1.5 percent per year. Over a 10-year period, these women have a significantly higher risk than average of getting a breast cancer in the opposite breast.
The decision to have a bi-lateral mastectomy when cancer has been detected in one breast is complex. There have been retrospective studies done by the Mayo Clinic over a period of 30 years that show removal of the breast reduces your breast cancer risk by 94 to 97 percent. If you are a 55-year-old woman who anticipates living to be 95, that’s a 40-year survival. That means, in your lifetime, you have about a 20-40 percent chance of getting a breast cancer in the opposite breast by the time you are 90. Additionally, if you do get another breast cancer, the risk of it spreading to other parts of your body are higher.
I don’t recommend a bi-lateral mastectomy to every woman. I think the ideal candidate is a young woman who has a great deal of fear of dying from the cancer, has a risky cancer such as a lobular cancer or a highly aggressive tumor who asks what she can do to reduce her risk of having the cancer come back. If she can envision herself without breasts or with reconstructed breasts, a bi-lateral mastectomy could be a good decision. If she cannot envision herself as being socially acceptable without breasts or with reconstructed breasts I think it is the wrong operation for her.
While cancers have some common features, the journey is unique for every patient. The treatment should be chosen to fit the patient and the cancer