Sharpe [1] and colleagues used the National Cancer Data Base to study the effect of bilateral mastectomy for early-stage breast cancer on length of hospital stay, readmission rate, 30-day mortality, and time to adjuvant therapy.
The authors begin by acknowledging the recent increase in bilateral mastectomies for patients diagnosed with early-stage breast cancer, a trend that is entirely driven by patients rather than experts. They also point out that surgeons typically address reasons for and possible benefits of different procedures and often leave out the possible (unintended) harm caused by such procedures or options. In this case, it is important for clinicians to figure out whether a delay in the initiation of chemotherapy could result in harm.
Longer wait times may be related to the practice of obtaining additional preoperative imaging with MRI, or consultations with plastic surgery or genetic specialists for second opinions. National guidelines from the National Comprehensive Cancer Network and the National Quality Forum recommend adjuvant chemotherapy to be administered within 120 days of diagnosis of breast cancer.
What is your opinion?
Reference:
1. Sharpe SM et al. Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003-2010: A Report from the National Cancer Data Base. Ann Surg Oncol. 2014 Apr 12.
Agree - the question is not 'could we do it but..should we do it'. The hysteria is somewhat media driven and the drive to raise awareness about family history risk has probably swung the pendulum too far. Add reconstruction to the surgical procedure and a simple day surgery procedure has become a major surgical event with prolongued recovery and greater risk of complications leading to delays in commencing adjuvant therapy in some instances. Yes - for high risk cases, bilateral treatment may be warranted but this is surely the minority of patients.
I fully agree with Prof Vaidya. Also the economic aspect should be stressed. At least in Europe who will pay for all these unnecessary mastectomies and reconstructions? In each country the National Health Systems have a shortage of resources and this kind of waste of money is unacceptable!
There should be a great deal of emphasis on high quality pre-operative consultation for these patients and highly integrated services between breast surgeons, reconstructive plastic surgeons (like me) and oncologists. Many patients I see, once they have all the relevant information, decided against contralateral prophylactic mastectomy, but the timliness and quality of consultation is vital. In those patients who do benefit from bilateral mastectomy and reconstruction, as long as the services are well integrated the procedure should be able to be performed without any delay to adjuvent therapy. Saying this, it is my preference to save immediate reconstruction for those who have DCIS only or have no disease but a high genetic risk.
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