Bilateral Breast Cancer

  • Synchronous and metachronous bilateral breast cancers:
    • Appear in 1% to 20% of patients with breast cancer
  • Improvements in screening and the increased use of MRI:
    • Often diagnose more early-stage synchronous bilateral cancer
  • The role of MRI in the preoperative planning:
    • Is controversial and may be partly responsible for increasing mastectomy rates in the United States
  • MRI may identify additional lesions in both the ipsilateral and contralateral breast in many women diagnosed with unifocal breast cancer:
    • Many of these additional lesions are often found to be benign once additional diagnostic imaging is performed and biopsies are completed
    • Additional MRI findings should not prompt surgeons to recommend mastectomy:
      • Unless they are biopsy-proven to represent additional sites of malignancy not amenable to breast conservation, and/or the patient was inclined toward mastectomy prior to MRI findings
  • Retrospective studies evaluating the outcomes of synchronous bilateral breast cancer:
    • Are limited by small cohort sizes, differing definitions, and non-matched unilateral patients as controls
    • Most retrospective studies show no differences in local recurrence or survival for bilateral breast cancers:
      • Making bilateral breast-conserving treatment a safe option for early-stage synchronous cancers
  • References
    • Heron DE, Komarnicky LT, Hyslop T, Schwartz GF, Mansfield CM. Bilateral breast carcinoma: risk factors and outcomes for patients with synchronous and metachronous disease. Cancer. 2000;88(12):2739-2750.
    • Intra M, Rotmensz N, Viale G, et al. Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution. Cancer. 2004;101(5):905-912.

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