CPM for early stage breast cancer lacks evidence for survival benefit in average risk women with unilateral breast cancer. CPM can be associated with chronic pain, poor cosmetic outcome, and doubles the risk of post-operative infection and bleeding. Recommended surgical options for treatment for a unilateral early breast cancer in average risk women include lumpectomy and nodal staging or unilateral mastectomy and nodal staging. CPM is recommended for women with unilateral breast cancer and previous Mantle field radiation or a BRCA 1/2 gene mutation. CPM can also be considered by the surgeon on an individual basis for women with unilateral breast cancer and a genetic mutation in the CHEK2/PTEN/p53/PALB2/CDH1 genes, and in women who may have difficulty achieving symmetry after unilateral mastectomy. In all cases, the rationale, risks, and benefits of CPM should be discussed with patients and carefully considered based on each individual patient’s particular situation. For more information:
Fayanju OM, Stoll, CR, Fowler, S, Colditz GA, Margenthaler JA. Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg. 2014 Dec; 260(6): 1000–1010. PMID: 24950272.
Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C, Tung N, Kim-Sing C, Eisen A, Foulkes WD, Rosen B, Sun P, Narod SA. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ. 2014;348: p226. PMID: 24519767.
Wright, FC, Look Hong NJ, Quan ML, Beyfuss K, Temple S, Covelli A, Baxter N, Gagliardi AR. Indications for contralateral prophylactic mastectomy: a consensus statement using modified Delphi methodology. Ann Surg. 2018 Feb;267(2):271-279. PMID: 28594745.