Contralateral prophylactic mastectomy: a voice for choice

In response to a growing a body of data showing an increase in the performance of bilateral mastectomies for the treatment of unilateral breast cancer (1-6) there has been a strong rebuttal literature criticizing this approach and implicitly the surgeons who perform contralateral prophylactic mastectomy (CPM) (7,8). It is interesting to observe that two decades after a concerted international effort to endorse breast-conserving surgery (versus mastectomy) as the default treatment for early breast cancer (9,10), the pendulum is now swinging back and mastectomy and CPM rates both are increasing. However, there is a common thread in these two trends: patient choice. Initial skepticism over the oncologic safety of breast-conserving surgery was overcome and ultimately successful because it provided women with a choice in treatment that enhanced well-being. Notably the recent increase in CPM rates has paralleled the burgeoning access to online information and extensive social networking. Current estimates suggest that more than 50% of the global population is online and two-thirds of the population of developed countries participate actively in at least one social networking site (11). As a result, more and more patients are coming proactively to their surgeons with a treatment plan in mind.