Contralateral Prophylactic Mastectomy (CPM)

It seems like “back in the old days” people tended to listen more to what their body was trying to tell them. For example, when we get sleepy, thats for a reason. Our body is trying to tell us we need to take a break, rest our minds so that our immune system can work without us getting in the way. Sometimes we may crave salt for a reason because our body may be telling us it needs a certain chemical for a balanced blood stream. Have you ever thought about how it seems cats and dogs or animals listen more than we do? A farmer may put a salt block out in the fields on a hot day. The horses do not just rush up and lick the salt block away. They will go and lick the salt block when their body tells them they are in need of sodium.

Animals listen more to their bodies than we do now. Have you ever pondered the thought that we now live in a fearful society and we have become fearful people as a whole?

More and more women are opting to remove a healthy breast after a breast cancer diagnosis.  According to a new study co-led by the American Cancer Society, more women believe its safer to remove both breasts when one has already has diagnosed with cancer.  Breast cancer is the most common form of cancer, second to skin cancers in the U.S., making up almost a third, or 29%, of all new cancer diagnoses.

Even though breast cancer is the second leading cause of cancer deaths among women, these rates of mortality have been declining over the years, probably due to medical advances and public awareness campaigns to prompting women to get checked for detection of cancer in the early stages.

The importance of regular screening and early detection of breast cancer among middle-aged women is responsible for successful treatment according to the American Cancer Society (ACS).

The journal JAMA Surgery has published a new study that investigated those who were diagnosed with early-stage cancer in one breast and opted for a preventive mastectomy in the other breast.  The scientists from the ACS, in collaboration with Emory University in Atlanta, G, along with the American Cancer Institute and the Brigham and Women’s Hospital, Boston, carried out the research.  This preventive surgery is called contralateral prophylactic mastectomy (CPM).  This procedure has increased significantly in the U.S. over the past 10 years.

The study included 1.2 million women aged 20 and over with the diagnosis of early-stage invasive unilateral breast cancer who underwent surgery between January 2004 and December 2012.  Patients examined in the study had their surgeries in 45 states across the U.S. and D.C. and accessed by the researchers and were collected by the North American Association of Central Cancer Registries.  A national increase was found in CPM over the 8 years studied.  The percentage of women undergoing CPM in 2004 was 3.6 and rose to 10.4 among those aged 45 and over.  In the states Colorado, Iowa, Missouri, Nebraska and South Dakota, over 42% aged 20 to 44 received CPM between 2010 and 2012.  Women aged between 20 and 44 in New Jersey who opted for CPM after an early-stage breast cancer diagnosis increased from 14.9% between 2004 and 2006, to 24.8% in 2010 to 2012.  In Virginia the percentage increased 3-fold from 9.8 to 32.2%.

Even though there has been an increase in reconstructive surgery among these women between 2004 and 2010, there was no correlation between this trend and the number of women who chose to undergo CPM.  The highest proportions of young women undergoing the reconstructive surgery among young women with CPM were geographically in Massachusetts, Maine, New Jersey, Connecticut, New York and Delaware rather than in the Midwestern region where the highest proportions of women who underwent a CPM were observed.  They were unable to draw a connection between the use of MRI screening and CPM.  There have been reports of an increase in the use of MRI and high-risk genetic testing among patients with breast cancer coinciding with the increase in the proportion of patients undergoing a CPM nationally.  The use of MRI and high-risk genetic testing is unknown by state and they were unable to assess their contributions to the state variation in the proportions of CPMs among women with breast cancer treated with surgery.

Study senior author, Ahmedin Jemal, Ph.D.,  feels that future studies should examine patient, clinical, and health system-level factors to provide additional insight into the reasons for temporal changes and regional variation in the receipt of a CPM.  Patients should also be educated about the benefit, harm and cost of a CPM to help patients make informed decisions about their treatments.

Dr Fredda Branyon