Average Risk Women Who Should Not Have CPM

The discussion of risk of contralateral breast cancer (CBC) with newly diagnosed breast cancer patients is highly charged. The rates of contralateral prophylactic mastectomy (CPM) continue to rise in the United States despite insufficient data demonstrating a survival benefit to the CPM.1 CPM is the best risk reduction strategy. However, there is a large gap between perceived risk of future cancer and actual risk of CBC development. In addition, great advances have been made in the treatment of breast cancer that the rates of CBC are declining. According to recent SEER data, the 5-year cumulative incidence of CBC ranged from 1% in younger women (age < 50 years) with a first ER-positive tumor to 1.9% in younger women with a first ER-negative tumor.2 Older age at first breast cancer diagnosis demonstrated lower rates. Having said that, the risk of CBC is twice the risk of an unaffected women same age and race getting their first sporadic breast cancer. The risk may be even higher in women with a hereditary breast cancer syndrome.3 Not all genes confer the same level of risk of CBC and not all mutations within the same gene (such as CHEK2) produce the same risk level. This session is meant to explore the variability in risk of CBC following the first breast cancer in women with and without hereditary predisposition and differentiate who would benefit from a CPM and who would not.