Bilateral breast cancers

A second primary cancer in the opposite breast may be found either at the time of the initial presentation (synchronous tumour, 0.5-2%) or more commonly at a subsequent date (metachronous cancer, 3-9%). A woman who has a primary breast cancer has a four- to sixfold risk of developing a cancer in the opposite breast. Other risk factors for the development of a cancer in the opposite breast include LCIS and multifocal disease.

The prognosis for patients with bilateral breast cancers depends on the staging of the tumours and treatment should be appropriate for the disease stage. Patients who have a genetic predisposition (mutations of the putative breast cancer gene(s) and associated genomic abnormalities (e.g. loss of het-erozygosity of the p53-suppressor gene)) are at very high risk of developing bilateral breast cancers. In these patients, consideration may be given as to whether prophylactic mastectomy (with or without reconstruction) should be undertaken.

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