More Mastectomies at Mayo Clinic
Posted 7/30/2009
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A recent report from the Mayo Clinic indicates that more women are electing to have mastectomies than has been true in the recent past. Here is the headline:
"More women have been having mastectomies to treat early stage breast cancer at the Mayo Clinic since 2004 than during the previous 6 years, according to an analysis of surgeries done at the clinic between 1997 and 2006. While the reasons for the apparent shift are not known, the rise in mastectomy rates marks a reversal—radical surgery to remove the breast had been in decline in the United States, and at the clinic."
The decision between mastectomy and breast convering surgery/wide excision/lumpectomy is often difficult. Sometimes, due to the size or location of the tumor, multi-centric breast cancer (multiple tumors in one breast), or a second breast cancer in a previously radiated breast, there is no choice and a mastectomy is the only recommended treatment. Women who carry a positive gene mutation (BRCA1 or BRCA2) are often told that their safest strategy is bilateral mastectomies. In other circumstances, women are usually given the choice, told that there is no difference in survival between the two surgeries, and "expected" (and I choose that word carefully) to opt for lesser surgery. The availability and success of the smaller surgery has been a medical triumph, and it has been surprising to many doctors that more women seem to be making the mastectomy decision.
From where I sit, as a two time survivor and a clinician, I easily understand the anxiety of the first weeks after diagnosis and the wish to do anything to stay well and keep cancer away in the future. I have known a number of women who have opted for mastectomy, in spite of their doctors reassuring them that they don't need to lose a breast, and who have never regretted the decision. I know other women who have decided to live with the anxiety for a while, proceed with a lumpectomy and radiation, and know they can return for a mastectomy if they later decide it is right for them. Many, probably most, women opt for breast conserving surgery and are glad to have done so.
There is a lot of concern in the medical world that women are not always adequately informed about their choice, the relative risks, the realities of each surgery. I am a strong supporter of the individual's right to choose and enough information to make the decision that is right for her. It reminds me of one of the things I have tried to teach my daughters: Sometimes, there is the decision that the world thinks is right and another decision that is right for you.
If you want to read more: http://www.cancer.gov/ncicancerbulletin/072809/page1
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