Contralateral risk-reducing mastectomy in sporadic breast cancer
A partir d'une revue de la littérature, cette étude américaine identifie les raisons d'une augmentation, sur les quinze dernières années, du nombre de mastectomies pour réduire le risque de cancer controlatéral chez les patientes atteintes d'un cancer sporadique du sein, puis analyse le rapport bénéfices/risques d'une telle intervention chirurgicale
Recent studies have shown that the number of women undergoing risk-reducing mastectomy has increased rapidly in the USA in the past 15 years. Although a small rise in the number of bilateral risk-reducing procedures has been noted in high-risk gene mutation carriers who have never had breast cancer, this number does not account for the overall increase in procedures undertaken. In patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, contralateral risk-reducing mastectomy is often, but not universally, indicated. However, many patients undergoing contralateral risk-reducing mastectomy might not be categorised as high risk and therefore any potential benefit from this procedure is unproven. At a time when breast-conserving surgery has become more widely used, this sharp increase in contralateral risk-reducing mastectomy is surprising. We have reviewed the literature in an attempt to establish what is driving the increase in this procedure in moderate-to-low-risk populations and to assess its justification in terms of risk—benefit analysis.