In this month of Breast Cancer Awareness, as women proceed with mammography screening, some may be faced with a newly diagnosed breast cancer. In addition to the decisions regarding treatment of the cancer, some also face the decision of how to manage the opposite breast.

That decision will depend on :

· The presence or absence of known high risk mutations like BRCA.

· If she’s had previous breast issues leading to detection of this cancer.

· Her family history and risk for “contralateral” or new breast cancer in the opposite breast.

· The nature and size of her primary breast cancer: high grade versus low grade cancer.

· The size and nature of the breasts, whether easy or difficult to monitor, or if a one-sided mastectomy would cause imbalance.

· The need for immediate treatment for breast cancer. Would the second mastectomy cause a delay?

· Anxiety about developing a second breast cancer, which can be disabling.

There are situations where we would recommend proceeding with the preventive mastectomy at the same time. Other situations may suggest a delay in preventive surgery. This decision should be discussed with the surgeon and oncologists for an informed decision regarding reasonable options.

Here is a link to a discussion in the New England Journal of Medicine.

http://www.nejm.org/doi/full/10.1056/NEJMclde1708293#t=cldeOpt2