Consenso sobre mastectomía profiláctica contralateral. Resultados y riesgos.
Contralateral Prophylactic Mastectomy (CPM) Consensus Statement from the American Society of Breast Surgeons: Data on CPM Outcomes and Risks.
Authors: Judy C. Boughey, Deanna J. Attai, Steven L. Chen, Hiram S. Cody, Jill R. Dietz, Sheldon M. Feldman, Caprice C. Greenberg, Rena B. Kass,Jeffrey Landercasper, Valerie Lemaine, Fiona MacNeill, David H. Song, Alicia C. Staley, Lee G. Wilke, Shawna C. Willey, Katharine A. Yao, Julie A. Margenthaler.
October 2016, Volume 23, Issue 10, pp 3100–3105
The American Society of Breast Surgeons (ASBrS) endorses the American Board of Internal Medicine’s Choosing Wisely campaign statement: “Don’t routinely perform a double mastectomy in patients who have a single breast with cancer.”1 However, women with a newly diagnosed unilateral breast cancer are increasingly opting for bilateral mastectomy. This has been seen in patients who are candidates for breast conservation who elect mastectomy as well as those requiring mastectomy for their index breast cancer.2 National rates of contralateral prophylactic mastectomy (CPM) in the United States have been increasing and this trend is continuing.2–4
There has been significant controversy surrounding this topic, and it has received attention from national societies as well as the media. Therefore, the ASBrS convened a panel of experts to develop a consensus statement on CPM. Initial literature review was performed and exchanged electronically by the panel, followed by an in-person meeting of the consensus group and polling of the membership of the ASBrS at the 2016 annual meeting. The consensus statement consists of two parts. This paper, part 1, outlines the data on the impact of CPM on cancer and noncancer outcomes, including risks of CPM and when CPM should be considered or discouraged. Part 2 outlines whether CPM utilization should be a quality measure, role of sentinel node biopsy for CPM, perspectives on CPM from patients and from providers in other countries, and counseling considerations for patients desiring CPM and includes a discussion template for providers to use with patients regarding CPM. The ASBrS Executive Committee reviewed and approved the statement. This consensus statement was developed to guide patient and physician discussion and should not affect insurance coverage.
The consensus group agreed that CPM should be discouraged for an average-risk woman with unilateral breast cancer. However, patient’s values, goals, and preferences should be included to optimize shared decision making when discussing CPM. The final decision whether or not to proceed with CPM is a result of the balance between benefits and risks of CPM and patient preference.
Acceda al artículo completo aquí: https://link.springer.com/article/10.1245/s10434-016-5443-5
