Prophylactic Mastectomy - an ounce of prevention is worth 5% of cure

Sometimes things that are so obviously intuitive still have to be validated. After a number of years of controversy, an increasing utilized surgery to prevent breast cancer is now being shown to be quite effective in both risk reduction and cancer-related mortality. The study "A Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients" is published in the Journal of the National Cancer Institute and can be seen here.

Contralateral prophylactic mastectomy, (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, clearly appears to offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative. We've known for several decades that CPM reduced the risk of developing breast cancer, but it was always more elusive to show that it actually saved lives at the end of the day. The practice of CPM has expanded significantly, with >150% growth in the number of such surgeries since the late 1990's.

How effective is CPM? Those younger than age 50 with early stage cancer with ER negative disease had a survival benefit of almost 5% at five years.  For a therapeutic intervention for cancer, 5% is really substantial. You can take it to the bank that following these patients out even farther that we will show increased survival benefit with longer follow-up in the population. This is due to the fact that

1. the patient's likelihood of getting a second breast cancer in the non-removed breast increases with time
2. patients with prior breast cancer are among the highest risk group for developing breast cancer

Women older then 50 have a little more complicated decision. In cold, hard actuarial terms you are more likely to die from something else before a new breast cancer would kill you. On the other hand, steadily increasing lifespans of adult Americans has made some of these kind of statistical bets have to be reexamined. I would guess that the reported benefit of CPM gradually increases towards 60 years in future clinical guidelines.

Rob

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Study confirms that breast implants do not affect breast cancer survival

A recent Canadian study long term follow-up (see here) confirms prior observations that women with breast implants who go on to develop breast cancer have similar outcomes as women without implants who develop cancer. This is more reassurance to our patients about this theoretical concern with implants (ie. that potential difficulty with mammograms would lead to delayed breast cancer diagnosis and worse outcomes). Along a similar vein, women with implants actually have a much lower (~ 40% lower I think) rate of breast cancer as compared to peer groups in the population.

Rob

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From Chest to a Desk

On Wednesday night, my friend Ashley and I went to the filming of America’s Got Talent with judges Howie Mendal, Peirs Morgan and Sharon Osbourne. While the show itself was really funny and entertaining, it seemed all of the reporters and press at the filming wanted to know about was what Osbourne was going to be doing with her 34DD breast implants.

Osbourne recently revealed to the Today Show on NBC that she plans on having the removed and is apparently even giving them to her rock star husband Ozzy to use as paper weights.

Here are some tips about how to go about removing silicone or saline breast implants:

Carefully make an educated decision to remove your implants based on your health, self-esteem, economic situation and advice from your medical professionals.

Consider the option of an implant exchange: a procedure to replace older implants of the same size or to a smaller size.

Ensure that you are economically secure to afford the cost of surgery.

Prepare yourself mentally for the change in your external self after you have the surgery.

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