Bilateral mastectomy for DCIS – pro
DCIS is a precancerous state that involves both breasts. Treatment options for DCIS are mastectomy, breast conserving surgery (BCS) plus radiotherapy or BCS alone. Because both breasts are at risk, some experts have suggested bilateral prophylactic mastectomies but guidelines do not recommend it as a standard option. The American Cancer Society Board of Directors has stated that “only very strong clinical and/or pathologic indications warrant doing this type of preventive operation.”
British Columbia guideline says: “Bilateral mastectomy is not normally indicated for patients with unilateral DCIS”. This is also the conclusion of other guidelines.
It is generally acknowledged that there has been a trend to increasing use of bilateral mastectomy. However, it appears to be driven by the Federal mandate to pay for breast reconstructive surgery and patient demand and not by acceptance by guidelines.
NCCN does not recommend it on p. DCIS-1.
http://www.cmaj.ca/cgi/reprint/165/7/912.pdf (Clinical practive guidelines for the care and treatment of breast cancer, Guideline 5: The Management of ductal carcinoma in situ (DCIS), Rev. Oct. 2, 2001, © 2006 CMA Media Inc. or its licensors.)
http://www.bccancer.bc.ca/HPI/Nursing/Education/breastcancer/treatmentoptions/noninvasive.htm#dcis
Schwartz GF, Solin LJ, Olivotto IA et al. Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22–25, 1999. Cancer 2000; 88: 946–954.
Ductal carcinoma in situ. In: New Zealand Guidelines Group. Management of early breast cancer. Wellington (NZ): New Zealand Guidelines Group (NZGG); 2009. p. 133-41.
ACR 2011 – Ductal carcinoma in situ. In: New Zealand Guidelines Group. Management of early breast cancer. Wellington (NZ): New Zealand Guidelines Group (NZGG); 2009. p. 133-41.