Preventive Mastectomy in Opposite Breast Boosts Survival Only Slightly

Benefit largely for young women with early stage, ER-negative tumors, study finds

By Kathleen Doheny
HealthDay Reporter

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THURSDAY, Feb. 25 (HealthDay News) -- Women with breast cancer who choose to have a preventive mastectomy on their disease-free breast do reduce their risk of cancer in that breast, studies have shown.

But now new research finds that the survival benefit from that preventive surgery is small and not equal among all women.

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"The survival benefit was limited to a small subset of all breast cancer patients [studied]," said study author Dr. Isabelle Bedrosian, an assistant professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center, in Houston.

Those most likely to derive a survival benefit, she said, were those younger than 50 who had been diagnosed with early-stage cancers that were estrogen receptor (ER)-negative.

ER-negative tumors don't require estrogen to grow, as do ER-positive tumors, and the prognosis is poorer for the ER-negative cancers, according to the American Cancer Society.

The study is published online Feb. 25 in the Journal of the National Cancer Institute.

According to Bedrosian and others, experts have long known that women diagnosed with breast cancer have an elevated risk of developing cancer in the opposite breast. Removing that breast as a preventive measure reduces, but does not eliminate, the risk of cancer in that breast.

"But we have never really established the difference it makes in the survival of breast cancer patients," she said. So, Bedrosian and her colleagues used data from the Surveillance, Epidemiology and End Results (SEER) database, evaluating 107,106 women with breast cancer who had undergone mastectomy for that cancer between 1998 and 2003, along with a subset of 8,902 who had the opposite breast removed as a preventive measure.

After a five-year follow-up, 88.5 percent of those who had the opposite breast surgery were alive, versus 83.7 percent of those who did not, a difference of less than 5 percent. The improved survival was clear for a select group, mostly the women aged 18 to 49 with early-stage, ER-negative tumors, the researchers found.

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