Keeping One Breast as a Diagnostic Tool?

Alaina

Keeping One Breast as a Diagnostic Tool?

Alaina

I was having a discussion a few days ago with a woman who is a 10+ year survivor, and I was curious as to the reason(s) she opted to keep one healthy breast instead of having them both removed.

I shared my reasons.  My surgeon told me that there was no statistical benefit (reducing risk of recurrence) in removing a healthy breast.  She was also concerned that since I was having so much trouble getting my red blood cells to rally post-chemo (I had chemo before surgery), that to do a bilateral would have been too much wear and tear on my body and my recovery would have been slower, and they wanted to get me into radiation as soon as possible after surgery.  She said I could always have my healthy breast removed later (at reconstruction) if I decided I really wanted it gone (for peace of mind reasons, etc).  I'm glad I followed her advice, but am still seriously considering getting it removed at reconstruction, but for aesthetic purposes only (don't want one saggy boob 10 years from now and one perky reconstructed one).

The woman I was talking to said that her surgeon told her to keep her healthy breast as a "diagnostic tool."  To essentially give the recurring cancer someplace "safer" to go: into a breast instead of an ovary, lung, or liver.  He felt that if the cancer was going to come back, if it had a breast to go into, it would, but without the breast it would go someplace else more dangerous.

I guess this makes sense to me, but it's also a little weird and confusing.

Has anyone else ever heard this?  Is that a really good reason to keep a healthy breast, or is it a crock of sh*t?  LOL!!!  Sorry, that was my initial reaction...

Alaina

ElaineD

I agree with your initial reaction! Unfortunately cancer is far too sneaky to behave as one would like/expect-if it's going to recurr, it'll set up home wherever it  chooses. After all, all it takes is one stray cell to circulate through the body-it would be nice to think it would autmoatically home in on the healthy breast, but I wouldn't take it for granted. In fact, it could be potentially dangerous to do so.

clariceak

I've been wondering the same thing myself.  I opted to have a bilat and then realized later that since my chance of reoccurence was high wouldn't it be better to have it occur in a body part that could easily be removed.

I've come close to posting this question myself, but felt too silly to do so.

KerryMac

My Surgeon told me that my biggest threat was the cancer I have already had. That the chance of a new primary is slightly higher that average, but that my ooph and "theoretically" the Arimidex would also lower that risk.

A friends surgeon very succinctly told her "the cancer you already had is the one that will kill you" Got to love those Surgeons.

By all means do it for cosmetic reasons though. 

PS73

I asked the same question to my oncologist who said, a bilateral mastectomy does not increase your chance of mets. 

Anonymous

Alaina - I have wondered the same thing.  If you decide to keep the healthy breast you can always have it surgically "matched' with a lift, reduction, implant - whatever direction you need to avoid the one "saggy boob" and perky new friend!  This is all covered by insurance for symmetry.

cookiegal

Actually I have heard the same thing from a friend who works at a bc center. She feels cancer that ended up in the chest wall of a mast patient might have gone into the breast instead. That is purely anecdotal though.

I don't think you can tell it to turn right though.

I will add she is not a doctor or nurse but a patient representative, so take that with as many grains of salt as you wish.

Pure

I was told that double masectomy followed by rads reduced my chance of reoccuernce of  new primary to 1-2%. That is why I am doing it. But that seems really crazy but I actually thoought of that before. But it also seems that people who get it in the other breast get it quite bad.

TammyLou

I think it depends on your situation.  If you are young, you may have 40% risk of bc in "good" breast over your lifetime.

 This risk can be reduced by hormone blockers if the cancer you have had happened to be ER+.

My best understanding is that people who have had breast cancer are at higher risk of having more breast cancer and other (especially "female" type) cancers.

This is a difficult area.  Breast cancer is / can be both a systemic and a local disease.

Generally, a local recurrance is a harbinger of more disease. Bad joo joo....more likely to accompany distant disease than other / previous cancer.

Of course, no one actually knows the correct answer.  Speaking personally, I would be disinclined to keep a breast as a "diagnostic" tool. 

There is no evidence that having a boobie prevents distant mets.  I'd sooner read tea leaves.

tl 

LJMorris

My onc said no reason to cut off the other breast.  I know having one breast seems to help my bra stay in place.  I don't know if that is a reason or not but I trusted my onc advice and will keep a vigil watch. 

blondie45

LJMorris - I sure hope your onc is right. I wanted bilateral but my insurance company would not pay for the healthy side. I really do not like insurance companies dictating our care and choices.

LJMorris

Blondie,

Sorry about your insurance company. My insurance gave permission for both if I wanted it, but I opted for the one.  At first I wanted them both cut off immediately.  After gong through chemo, I still wasn't sure but when surgery day arrived I felt like taking the one would be OK.  I think it is a decision that is personal and each of us have to make and feel at peace with. Insurance companies should not make the decision. 

caaclark

I asked my docs if I should get rid of both when it was time for my mastectomy.  All my docs said no.  I had IDC.  If I had ILC I would have had both removed.  I remember asking one of my doctors if I should get rid of the "good" breast and I was told that breast cancer happening in the good breast was not my biggest risk and that I was more likely to get mets.  Another one of my docs said, "well, you might get brain cancer someday but we don't cut off your head."  Lastly, one of my docs said, "We only get rid of a breast for risk reduction, not anxiety reduction." 

Brenda_R

My SIL had IDC in one breast, and had that breast removed. Eight years later she had DCIS in the other and had it removed. I imagine that she would have had them both removed to begin with if she had known what she knows now.  I don't know what her receptor status was, other than not her2 positive. She had chemo and no rads with the first MX, and nothing but surgery with the DCIS.

She doesn't talk about it.

lewing

So glad I stumbled on this thread!  I thought I was weird for feeling *less* peace of mind after my unilateral mastectomy (turns out I wasn't a candidate for breast-conserving surgery), when so many other women choose mx precisely because it gives them more peace of mind.  My theory, entirely non-evidence based, was that the breast would give a local recurrence somewhere to go other than the chest wall.  Sort of like a decoy, as it were. 

 I've got a great relationship with my doctors, but I still felt too silly about this thought to ask any of them about it.  It was my private, middle-of-the-night worry.  At least now I know that others have had similar thoughts. 

(And I love cookiegal's comment: "I don't think you can tell it to turn right."  Too, too true.  I'll definitely keep that in mind.)

Linda

Pure

20% of local reoccurence turns into mets-this stat is not currently mixed into the stats calculator.

Brenda_R

Am I wrong in thinking that if you later get BC in the other breast, they don't consider it a recurrence, but a new CA? Seems I read that.

KerryMac

Yep, it would be a new primary. My BS said IDC doesn't "skip breasts"

lexislove

I am a young woman diagnosed with BC. You all already know that....

I think I am one of the minority of young woman to NOT opt for a bilateral mastectomy. I asked all my docs, and they all said no. My surgeon said that same thing as caaclarks..." you could get cancer of the lung or brain but are we going to cut it off to try to prevent....no."

Iam though ER+, and have changed my lifestyle habits , I had good babits before I just need some fine tuning...all things that help reduce recurrence. Im also planning an ooph.

I  have thought If I was to remove the healthy breast and develop BC in it, it would probably be at the chest wall because most of the tissue had been removed . VS NOT removing the tissue and having a "new primary" caught earlier and easier to treat.

This is MY rationing. Is it right? Who knows. But I feel better in my decision. I am getting a lift/reduction on my healthy breast to match my implant and my PS assures me that I will be happy. I have also seen pics of other survivors who have had his work.

I must add though, if I was TN or obviously had one of the BRCA genes, I would be doing a bilateral.

blondie45

lexislove - just curious do you know how they go about doing the lift on your other breast? Also thanks everyone for making me feel somewhat less frightened that I still have one breast left.

lexislove

blondie,

My PS says that he will do an "anchor" incision. So they will  make the incision around the nipple and then straight down. Best to google so you get a better idea...lol.

So scaring is less noticeable, he will remove breast tissue and then lift the nipple higher.

caaclark

I agree with what lexislove said.  I had the gene testing done and it came out neg.  If I had tested positive I definitely would have had a bilat.  Most people think I am crazy to still keep a breast but again, all my docs (and I have some excellent docs!) said no.

I am also ER+ and had a hysterectomy after about a year and a half of Tamox.

Attitude_Girl

I was advised by my surgeon that my chances of survival would not be different if I had partial mx with radio over full or bi lateral MX and that if the cancer comes back, which is likely under my DX, I have breast tissue for it to go into rather than the chest wall which would be a lot harder to deal with. I'm checked every 12 weeks so am happy that I went with him and feel secure in the knowledge that I have tried to give my self the best chance and hopefully more time even if I lose a boob/boobs a bits at a time.

TammyLou

My best understanding for Stage I and II cancers is that lumpectomy and rads are similar in outcome to mastectomy.

The risk of a new cancer and/or recurrance is generally less for people who have ER+ cancers who are able to take follow-on tamoxifen/hormonals.

tl 

PS73

I was told the opposite actually.  I was told the tamoxifen is taken to reduce recurrance such as mets from the original cancer. I was told the bmx would reduce a new cancer by 30% over thirty years.  Lump+rads or bmx have a five percentish difference in recurrance however a lump +rads has a 1% increase per year for a new bc if you've already had bc.  Your estrogen receptors are blocked by tamoxifen so the (potential) lingering cancerous cells cannot attach to tamoxifen or estrogen and spread thru your system.

A new cancer and a recurrance are very different animals and should be treated as such. 

blondie45

KatieFantasia - So glad you like your doctor, that helps so much.

lexislove - Thanks for explaining how that works.