Prophylactic mastectomy is recommended only for women at high risk for developing breast cancer, according to new guidelines released by the National Comprehensive Cancer Network. The guidelines also adjust recommendations for lymph node testing and invasive breast cancer chemotherapy.
The guidelines were developed by physicians with expertise in breast cancer prevention, diagnosis, treatment and recovery.
Prophylactic Mastectomy Guidelines
More and more women have a prophylactic mastectomy, the removal of the opposite, noncancerous breast, because they feel doing so could prevent a new cancer from forming there.
The new guidelines state that prophylactic mastectomy is discouraged if you have cancer in your other breast and no other risk factors. Women with BRCA mutations or a family history of breast and/or ovarian cancer and women who have lobular carcinoma in situ (LCIS), a condition in which breast cancer is present in the lobules of the breast, are still considered candidates for prophylactic surgery, because they are at higher risk for developing cancer in the opposite breast.
In considering prophylactic mastectomy, the guidelines encourage you and your doctors to discuss:
- The small benefits of prophylactic mastectomy compared to the risk of breast cancer recurrence from the cancer that already was found
- The emotional and practical concerns of bilateral mastectomy
- The overall health risks of contralateral mastectomy
Lymph Node Testing
The guidelines also remove the recommendation for a full axillary lymph node dissection (ALND), or the surgical removal of all lymph nodes in the underarm, for women with stage I or II breast cancer whose lymph nodes are not swollen during physical exam.
These women should have sentinel node mapping and excision by a team of physicians with experience in sentinel node biopsy, the new guidelines say. Sentinel node mapping and excision involve testing and removing one or a few lymph nodes. Compared to ALND, this procedure may decrease the risk of post-surgical pain and lymphedema, when lymph fluid builds up in the arm causing chronic swelling.
The guidelines also add a new chemotherapy combination for invasive breast cancer, or cancer that grows out of the ducts or lobules of the breast into the surrounding tissues. After surgery these women may have the option of fluorouracil (brand name: Adrucil), epirubicin (brand name: Ellence), and cyclophosphamide (brand name: Cytoxan) followed by weekly paclitaxel (brand name: Taxol).
What Do these Updates Mean for Me?
These guidelines for early-stage disease will help you and your doctors discuss your options for surgery and chemotherapy. If you are about to have your lymph nodes tested or you need chemotherapy, these guidelines could provide more options for your treatment with a smaller risk of side effects.
Your doctor may encourage you to think about your options if you are considering prophylactic mastectomy. You also may need a special appointment so you can learn about the risks and benefits.
National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Breast Cancer. nccn.org. October 2009.
Learn more about the NCCN guidelines (you must register to access them).