More Women Opting for Bilateral Mastecto
Although this study was published more than a year ago, I just came across this article in my files and thought it may be of interest to many of you. In my practice, both when I meet individually with women and during support groups, we often have active conversations about choosing (when not medically necessary) to have a mastectomy. I have known some women who did make this decision, but it inevitably a very difficult and distressing problem. In considering the issue, it seems most important for a woman to be well-informed--both about her medical situation and the risks/benefits of each surgical choice, and to take time to carefully consider her options. It is not unusual for a woman, in the initial crisis and panic of diagnosis, to think she wants bilateral mastectomies, and then to later feel that less surgery is a wiser choice.
October 23, 2007
Study Finds Rise in Choice of Double Mastectomies By RONI CARYN RABIN
More women with breast cancer are choosing to have their healthy breast surgically removed along with their affected breast, a new study has found. Almost 5 percent of patients decided to have the radical procedure in 2003, up from just under 2 percent in 1998.
The study, published in The Journal of Clinical Oncology online, analyzed data from a small fraction of the estimated 200,000 women who receive breast cancer diagnoses in the United States each year. If the figures are accurate, 8,000 to 10,000 patients a year may be electing to have the procedure, called a contralateral prophylactic mastectomy.
"Some people may think it's kind of crazy, but you don't know what you're going to do until you yourself are faced with the situation," said Darcy Long, 44, of Maple Grove, Minn., who had a double mastectomy after breast cancer was diagnosed in her right breast last July.
From the start, Ms. Long said; "There was no question in my mind. I was going to have a mastectomy on both sides. I wanted to maximize my survivability, and I didn't want to ever think that I hadn't done everything that I possibly could to prevent this from coming back."
The study's lead author, Dr. Todd M. Tuttle, chief of surgical oncology at the University of Minnesota Medical School, started the study because so many patients were requesting the procedure. Still, Dr. Tuttle said, he was surprised by the increase in contralateral prophylactic mastectomies, an upward trend that shows no sign of leveling off and is occurring even as the practice of breast-conserving surgery expands.
"The comment patients make is, 'I just want to be done with it,'" he said. "They never want to have another mammogram again; they never want to have another biopsy again."
He and other experts emphasized that though the removal of the healthy breast sharply reduced the risk of a new cancer developing in that breast the risk is not zero because some tissue can remain it was the cancer that had already been diagnosed that posed the greatest threat to a patient's life.
"For the vast majority of our patients, this does not impact the chances of dying of breast cancer, and that's the key thing here," said Dr. Julie R. Gralow, the chairwoman of the communications committee of the American Society of Clinical Oncology and an associate professor of medical oncology at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle.
"My first reaction to this study, because it came as a bit of a surprise, was, 'Oh, are we doing our job explaining that point to patients?'" Dr. Gralow said. "We want to support women in doing what feels right to them. But our job is to make sure they have all the accurate information."
The study used data from cancer surveillance registries covering about a quarter of the United States to identify 152,755 patients whose cancer was diagnosed in one breast from 1998 to 2003. The rate rose steadily, with 4.5 percent of all patients who received breast cancer diagnoses in 2003 having the surgery, up from 1.8 percent in 1998.
The numbers were much higher among women who had the breast with cancer removed, rather than a lumpectomy. That group was much more likely to choose to have the healthy breast removed, as well. In that group, 11 percent chose a double mastectomy in 2003, up from 4.2 percent in 1998. Patients with Stage 1 breast cancer chose the procedure more often than those with more advanced cancer.
"What we're actually seeing is more and more women at the two extremes: either having minimal surgery, a lumpectomy, or having a bilateral mastectomy," Dr. Tuttle said. "Fewer women are having just one breast removed."
Younger women, white women and women with a previous cancer diagnosis were more likely to opt for a contralateral prophylactic mastectomy, the study found, as were women who had lobular histology, meaning the cancer started in the lobules or milk-making glands of the breast.
Though the researchers had limited information about the patients, Dr. Tuttle suggested that younger women might be choosing the procedure because their cancers tended to be very aggressive, and they had more years ahead of them in which a second cancer might develop.
Though all women with breast cancer are at risk of developing a second cancer in the uninvolved breast, the risk is slightly greater with lobular histology, Dr. Tuttle said, and white women may be more likely to carry genetic mutations associated with an increased risk of developing cancer in the contralateral breast.
Several developments may be driving the trend toward prophylactic mastectomies, experts said. More women are undergoing genetic testing after a diagnosis of breast cancer, and improvements in both mastectomy and breast-reconstruction techniques have made the option of a double reconstruction less daunting.
Doctors and patients' advocates urged women considering the procedure to go for counseling and take their time before making a decision, noting that other risk-reducing options were available, like tamoxifen therapy for estrogen receptor-positive breast cancer and the use of more sensitive magnetic resonance imaging screening for earlier detection.
Copyright 2007 The New York Times Company