The article recently published online in the journal Cancer (due in print in their March issue) looks at the risks factors that increase the likelihood of a woman being diagnosed with breast cancer in her “other” breast after being diagnosed with breast cancer.
- having more than one tumor in the same breast at the time of initial diagnosis of breast cancer
- having invasive lobular breast cancer, which begins in the milk-producing glands called lobules rather than in the milk ducts, and then invades surrounding tissues
- having a high score in the so-called Gail model that calculates breast cancer risk and considers things such as age at first menstrual period, age when first child was born and whether close relatives like mother or sister had the disease.
Prophylactic mastectomy is recommended for either the treatment of breast symptoms or to prevent cancer from developing in the breast. Accepted indications for mastectomy include the presence of biopsy-proven tissue of uncertain behavior, the presence of microscopic foci of lobular carcinoma or ductal carcinoma in-situ, and both personal and family histories of breast cancer. In these high-risk patients, statistics support prophylactic mastectomy. Fibrocystic mastopathy may generate enough fibrosis to render mammography useless for cancer detection.Other indications for mastectomy and reconstruction include injected silicone mastopathy, a history of multiple breast biopsies, cancerphobia, progressive fibrocystic mastopathy preventing adequate examination, and refractory mastodynia.Definite indications for prophylactic mastectomy include lobular or ductal carcinoma in-situ; proliferative atypical dysplasi; severe dysplasia; personal history of breast cancer; personal history of breast cancer in opposite breast; one first-order relative with bilateral, premenopausal breast cancer; two first-order relatives with premenopausal breast cancer; desmoid tumor of the breast or giant fibroadenoma; cystosarcoma phylloides; significant virginal hypertrophy, and post-injection silicone mastopathy.Two or more of the following conditions also represent indications for prophylactic mastectomy: one first-order relative with premenopausal breast cancer, one first-order relative with postmenopausal breast cancer, obscured mammograms due to fibrosis, history of multiple breast biopsies, and refractory fibrocystic mastodynia.