New consensus statement discourages contralateral prophylactic mastectomy

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Women diagnosed with breast cancer who are at average risk should be discouraged from undergoing a contralateral prophylactic mastectomy (CPM), because the majority of women will obtain no oncologic benefit, says a new consensus statement from the American Society of Breast Surgeons (ASBrS). The first part of the statement outlines the effect that CPM has on relevant clinical outcomes and which patients might be appropriate candidates for CPM. While, the second part focuses on issues such as how patients feel about CPM. Key recommendations from the position paper are:

• Sentinel lymph node surgery on the CPM side should not be routinely performed

• CPM is a cost-effective strategy for women with BRCA mutations. At this time, there is insufficient evidence to support the concept of superior cost effectiveness for CPM in women with sporadic breast cancer and the cost effectiveness is highly dependent on the quality of life assumptions.
• Women should be counseled on the potential long-term outcomes of CPM on body image and sexuality.

• Shared decision making that includes a comprehensive discussion of risks and benefits of CPM is important.

• CPM counseling should include discussion of CPM, risks of CPM, rates of CBC, and ensure patients are engaged in the decision making, and making decisions that are concordant with their treatment preferences and personal values

The position statements are published online July 28, 2016 in the Annals of Surgical Oncology. (Source: Medscape)