whether to have a bilateral mastectomy--new determination of risk factors

[Lani]

whether to have a bilateral procedure for aesthetic reasons is a whole 'nother story, but now they have identified three risk factors which assist decision making ie, just how likely is one to have breast cancer in the contralateral breast:

Researchers Identify Risk Factors for Contralateral Breast Cancer: New information helps predict which breast cancer patients may benefit from preventive mastectomy of opposite breast
[MD Anderson Cancer Center News Room]
A preventive procedure to remove the unaffected breast in breast cancer patients with disease in one breast may only be necessary in patients who have high-risk features as assessed by examining the patient's medical history and pathology of the breast cancer, according to researchers at The University of Texas M. D. Anderson Cancer Center.
Their findings, published in the March 1, 2009 issue of Cancer, may help physicians predict the likelihood of patients developing breast cancer in the opposite breast (contralateral breast cancer), stratify risk and counsel patients on their treatment options.
"Women often consider contralateral prophylactic mastectomy (CPM) not because of medical recommendation, but because they fear having their breast cancer return," said Kelly Hunt, M.D., professor in the Department of Surgical Oncology at M. D. Anderson and lead author on the study. "Currently it is very difficult to identify which patients are at enough risk to benefit from this aggressive and irreversible procedure. Our goal was to determine what characteristics defined these high-risk patients to better inform future decisions regarding CPM."
According to the researchers, approximately 2.7 percent of women diagnosed with breast cancer choose to have CPM. Recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States. Potential reasons breast cancer patients choose to undergo CPM include risk reduction, difficult surveillance and reconstructive issues such as symmetry and/or balance.
To begin to classify such risk factors, researchers reviewed the cases of 542 women with breast cancer only in one breast who received CPM to remove the second breast at M. D. Anderson from January 2000 to April 2007. Out of this group, 435 patients had no abnormal pathology identified in the opposite breast, 25 patients had contralateral breast cancer identified at surgery, and 82 patients had abnormal cells (atypical ductal hyperplasia, atypical lobular hyperplasia and lobular carcinoma in situ) that indicate a moderate to high-risk for breast cancer development in the contralateral breast found at the time of surgery.
Further analysis of the patients with contralateral breast cancer revealed that a five-year Gail risk of 1.67 percent or greater; an invasive lobular histology; and multiple tumors in the original breast were all strong predictors for contralateral breast cancer. Patient race, estrogen receptor status and progesterone receptor status were not associated with increased risk.
"We went from having very little information on the benefit of this procedure for individual patients to identifying three independent and significant risk factors," Hunt said. "Each provides valuable insight into how likely a woman is to develop the disease in her other breast and enables physicians to make an educated recommendation if a patient will potentially benefit from CPM."
The Gail model, typically used for patients without breast cancer, evaluates factors such age, age at menarche, number and findings of previous breast biopsies, age at first live birth and number of first-degree relatives with breast cancer, has been validated in several studies to calculate the risk of developing an invasive breast cancer over the next five years. The five-year risk of 1.67 percent is traditionally used as the cutoff point for the definition of "high risk."
"We've always known contralateral breast cancer risk is not the same for all women and it is unnecessary to perform preventive mastectomies routinely. As we begin to clarify the specific risk factors, the number of women undergoing CPM may decrease and those with a low to moderate-risk may be more open to less extreme options for risk reduction, such as hormonal therapy and newer agents for prevention of breast cancer."
In addition to Hunt, other M. D. Anderson researchers contributing to this study include Min Yi, M.D., Funda Meric-Bernstam, M.D., Isabelle Bedrosian, M.D., Gildy V. Babiera, M.D., Rosa F. Hwang, M.D., Henry Kruerer, M.D., all in the Department of Surgical Oncology; Lavinia P. Middleton, M.D., in the Department of Pathology; Banu K. Arun, M.D., in the Department of Breast Medical Oncology; and Wei Yang, M.D., in the Department of Diagnostic Imaging.

ABSTRACT: Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy
[Cancer]
Background: Although contralateral prophylactic mastectomy (CPM) reduced the risk of contralateral breast cancer in unilateral breast cancer patients, it was difficult to predict which patients were most likely to benefit from the procedure. The objective of this study was to identify the clinicopathologic factors that predict contralateral breast cancer and thereby inform decisions regarding performing CPM in unilateral breast cancer patients.
Methods: A total of 542 unilateral breast cancer patients who underwent CPM at The University of Texas M. D. Anderson Cancer Center from January 2000 to April 2007 were included in the current study. A logistic regression analysis was used to identify clinicopathologic factors that predict contralateral breast cancer.
Results: Of the 542 patients included in this study, 25 (5%) had an occult malignancy in the contralateral breast. Eighty-two patients (15%) had moderate-risk to high-risk histologic findings identified at final pathologic evaluation of the contralateral breast. Multivariate analysis revealed that 3 independent factors predicted malignancy in the contralateral breast: an ipsilateral invasive lobular histology, an ipsilateral multicentric tumor, and a 5-year Gail risk ≥1.67%. Multivariate analysis also revealed that an age ≥50 years at the time of the initial cancer diagnosis and an additional ipsilateral moderate-risk to high-risk pathology were independent predictors of moderate-risk to high-risk histologic findings in the contralateral breast.
Conclusions: The findings indicated that CPM may be a rational choice for breast cancer patients who have a 5-year Gail risk ≥1.67%, an additional ipsilateral moderate-risk to high-risk pathology, an ipsilateral multicentric tumor, or an ipsilateral tumor of invasive lobular histology.

[dhealey]

They don't mention anything about the greater risk if the tumors were herceptin positive. I always thought that put you at a greater risk. They did find "Precancerous cells" in the breast tissue of the breast I had removed for prophylactic reasons. I for one am glad I choose bilaterl mastectomy.