Real versus Perceived Benefit of Preventive Mastectomy

[gail23]

I am 50 yrs old and had a lumpectomy and rads on my rt breast in 2000 for DCIS. In Feb of 2004 I had mastectomy and axillary followed by chemo with AC & Taxol for multi-focal invasive intraductal and lobular carcinoma in left breast.

After my mastectomy my Dr. indicated future options for my remaining (previously treated) right breast are to continue to monitor as in the past via mammograms, etc (which hasn't provided particularly early detection) or I could have mastectomy on that breast also. My question is in reference to responses I have seen in this and other forums where I have seen the mastectomy option for a currently unaffected breast identified as 'A Peace of Mind' measure, implying that it has no medical value as a preventive measure but instead provides 'A False Sense of Security' that just helps some people deal with it better. I am seriously considering removal of the 2nd breast but don't want to subject myself to additional surgery and disfigurement if there's no actual benefit to doing so in terms of the cancer management. Should I have a genetics test and only consider removal of the remaining treated breast if I have one of the cancer genes? Can you please clarify 1)whether I should consider removal of the previously radiated breast, 2) does the fact that I have had a new cancer affect answer to #1, 3) would mastectomy of radiated breast have REAL medical value as a cancer prevention (versus psychological only), i.e. what % increase in survivability 4) and does radiation provide adequate protection to not consider mastectomy? Thanks for a great forum!

[CCF-RN,MSN-rf]

Dear Gail23:  There is a difference between preventive mastectomy and mastectomy is a previously treated breast.  A preventive mastectomy, the way it is usually presented in this forum, is for women who have not had cancer in that breast but are at high risk (for a variety of reasons).  There is medical benefit to doing this but it does not elimiate all risk.  There are also women who have the BRCA gene that have both breasts removed to prevent breast cancer in either breast (no breast cancer has occurred).  There is medical benefit to doing this and there is also some peace of mind.  You have seen us use "peace of mind" but not "false sense of security."  Removing a breast that has been previously treated will virtually eliminate the possibility of local recurrence in that breast (this is the medical benefit) but it will not eliminate the possibility of recurrence elsewhere in your body.  Of course, there is no way to know if you would ever have a local recurrence in that breast.  In many cases, lumpectomy with radiation is definitive therapy.  So, at this point, the decision is personal and has more to do with benefit of local control of disease in the remaining breast which may have been accomplished with the lumpectomy and radiation therapy.