Bilateral Mastectomy Does Not Reduce Mortality in Contralateral Breast Cancer Patients

Giannakeas V, Lim DW, Narod SA. Bilateral Mastectomy and Breast Cancer Mortality. JAMA Oncol (2024).

Khan SA, Kocherginsky M. Contralateral Breast Cancer Remains a Complex Biologic Conundrum. JAMA Oncol (2024).

Diagnosis of contralateral breast cancer following lumpectomy or unilateral mastectomy is associated with significant risk for mortality; bilateral mastectomy at the time of initial diagnosis may reduce this risk. The purpose of this article was to examine the 20-year cumulative mortality rate for patients with contralateral breast cancer depending on the type of initial surgical treatment.

Data from a national cancer database (n = 661,270) was categorized according to the initial surgical procedure (lumpectomy, unilateral mastectomy, or bilateral mastectomy). The data showed that patients undergoing bilateral mastectomy had significantly fewer bilateral lesions diagnosed but cancer-related mortality risk was similar in all treatment groups.

The authors concluded that bilateral mastectomy was not associated with reduced mortality risk.

In the editorial that accompanied the article, Khan and Kocherginsky stressed the fact that many patients may choose bilateral mastectomy to avoid the stresses of long-term cancer surveillance, and bilateral mastectomy may be chosen regardless of the lack of a mortality benefit. Detailed counseling of patients was recommended to ensure that the best approach for each patient is chosen.