Mastectomy for risk reduction or symmetry in women without high risk gene mutation: A review

Prophylactic or 'risk-reducing' mastectomy refers to the procedure of completely removing a healthy breast in order to reduce the risk of developing breast cancer. This may be bilateral or may be performed to the contralateral breast as part of the treatment of a proven breast cancer. The rate of this procedure being performed has been shown to be increasing over the last two decades. Recent guidance for Breast clinicians has been issued over the last 12 months by both The Association of Breast Surgery of Great Britain and Ireland (ABSGBI) and the American Society of Breast Surgeons (ASBrS). This review aims to look at the evidence behind the current decision making for patients requesting to undergo this increasingly popular procedure.

We undertook a review of the relevant literature via Medline using the PubMed interface for the key words 'Breast Cancer', 'Mastectomy', 'Prophylactic', 'Contra-lateral' and 'Risk-reducing' for papers from October 1991 to 2016. The Association of Breast Surgery guidance on the topic was published this year and was therefore included and referenced. Following review of the evidence, we have categorised patients into different groups, based on their background and evidence currently available to support the decision.

Clear evidence exists to support offering contralateral prophylactic mastectomy (CPM) to women who are high-risk gene carriers for Breast cancer. For those without, no survival benefit is evident however other quality of life measures may be improved with access to the procedure.

For those women who are not high-risk gene carriers for breast cancer but have other factors that may increase their risk (strong family history, tumour characteristics) more evidence is needed as the benefit of CPM and all decisions to undertake it should occur through a multidisciplinary team approach.