Many Women Choosing Unneeded Double Mastectomies: Study
By Roxanne Palmer | November 29, 2012 5:42 AM EST
Many women that have both breasts surgically removed after cancer is detected in one breast may not actually need the procedure, a new study claims.
University of Michigan Medical School researcher Sarah Hawley presented a study examining 1,446 women who had been treated for breast cancer at a symposium of the American Society of Clinical Oncology. Though many of the study subjects were treated for less-serious early stages of breast cancer, 7 percent of them opted to remove both of their breasts, a move that in many cases may be medically unnecessary, Hawley says.
90 percent of the women that chose double mastectomy said they were very worried that the cancer would crop up again. But studies show that for most women, cancer in one breast does not raise the risk for cancer to show up in the other breast. The exception to this would be women with two or more immediate family members with a breast or ovarian cancer diagnosis, or women who know they carry mutations in the BRCA1 or BRCA2 genes that dramatically raise her risk for breast cancer.
But "for women who do not have a strong family history or a genetic finding, we would argue it's probably not appropriate to get the unaffected breast removed," Hawley said in a statement on Tuesday.
Double mastectomy is not a light procedure – it can mean more complications, more difficult recovery, and a patient may have to still submit to chemotherapy or radiation treatment regardless.
Hawley says she thinks that even though surgeons tell their patients that a double mastectomy won't cut their risk for recurrence and could endanger their lives, women still opt for the procedure out of fear. She's working on a tool to help guide women through their treatment options, thanks in part to a grant form the National Cancer Institute.
“A decision tool like ours will solicit common misconceptions about breast cancer treatment and give women feedback to help them fully understand the options and risks involved," Hawley says.
Over the past several years, mastectomy seems to be reemerging as a common treatment option in the early stages of breast cancer.
A study published in the American Journal of Clinical Oncology this past May paints a portrait of how mastectomy rates have risen in one region. The researchers, from the University of Louisville School of Medicine in Kentucky, studied data from their institution's cancer center on more than 1,600 women that had surgical treatment for stages 0 through II breast cancer between 1995 and 2008.
Over the entire 13-year period, nearly two-thirds of the women had surgery that did not entirely remove the breast, while the other third went through some form of mastectomy. Though the rate of mastectomy decreased from 43.5 percent to 22.5 percent between 1995 and 2004, between 2004 and 2008 there was a significant uptick in the proportion of patients having an entire breast removed, rising to nearly 52 percent of patients.
The researchers also found that uninsured and government-insured patients were more likely to receive a mastectomy than patients with private insurance.
“Additional study is needed to identify the underlying reasons for and unintended consequences of the reemergence of radical surgery for early-stage breast cancer in the era of multidisciplinary care,” the authors wrote.
Some women even take the radical step of electing to remove both breasts before there are any signs of cancer. And some of these women also happen to be celebrities that are vocal about their choice.
Earlier in November, Miss America contestant Allyn Rose announced that she was having a preventative double mastectomy. Rose's mother passed way in 2004 after fighting breast cancer for decades, with one episode in her late twenties and another in her 50s.
Rose also knew, thanks to genetic testing, that she was also at a high risk for developing breast cancer. Some doctors find the practice of preventative double mastectomy concerning, but most studies confirm that it's a valuable option for high-risk women.
One 1999 paper in the New England Journal of Medicine examined 639 women that underwent preventative mastectomy and found that the procedure reduces the rate of breast cancer in susceptible women by around 90 percent. Among the 425 women scored as moderate risk, models suggested there should have been around 37 patients with breast cancer; 4 breast cancers actually occurred.
The researchers also compared 214 patients scored as high-risk with 403 of their sisters that did not choose to have preventative breast removal. Nearly 40 percent of the sisters had a diagnosis of breast cancer, while only 1.4 percent of the patients that elected to have surgery developed the disease.
Though it might mean the end of her pageant career, Rose wasn't shy about choosing health over beauty standards.
"It's something that could help prolong my life," Rose told Good Morning America. "Anything I can do, absolutely, I'm on point with that."
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