Mastectomies in the News
This essay from The Boston Globe is about celebrity Giulana Rancic's recent decision to proceed with bilateral mastectomies and reconstruction. Full disclosure: I had never heard of her, but I am so totally out of it when it comes to any pop culture that my knowledge gap is not a surprise. I do admit to somewhat mixed feelings about this essay. Most importantly, of course, I am sorry that Ms Rancic has to deal with this problem, and I wish her a smooth recovery and good health. My ambivalence has to do with the minimization of the realities of this surgery and the lack of medical data to support the decision.
I have written a number of blogs about the increased incidence of bilateral mastectomies when there is no medical necessity for the surgery. Of course, there are all too many times when a positive BRCA mutation or an extensive family or personal history or the specific pathology of a diagnosed cancer make this the best choice. There are all too many other times, however, when the decision is based primarily on fear, the wish to avoid the annual anxiety around mammograms or breast MRIs, and an apparent lack of understanding of the realities of how breast cancer kills. Breast cancer does not recur (except very, very rarely) in the opposite breast. If there is a later cancer in the contralateral breast, it is a new/different one. Also, breast cancer in the breast alone is not a potentially lethal illness. The worry for us all is a recurrence or matastasis in another part of the body (usually bone, brain, lung, or liver); those are the mets that can kill us. That is, removing the other breast in and of itself is not a life-saving measure. The potentially life-saving measures are the systemic treatments of hormonal or chemo therapies for women who need them.
At any rate, here is the essay and my best wishes to Ms Rancic:
12/05/2011 1:24 PM
By Chelsea Conaboy, Globe Staff
Giuliana Rancic makes tough decision on double mastectomy
I have to give E! talk show host Giuliana Rancic credit for being so open with her breast cancer treatment. First, she revealed that her cancer was diagnosed via a mammogram that she had before her third round of fertility treatments. Then, she spoke about her lumpectomies to get rid of the multiple growths, and now she's revealed that she's going back to the operating room to have a double mastectomy and breast reconstruction instead of radiation treatments.
In an interview on the Today show this morning, Rancic and her husband Bill revealed that her previous lumpectomy didn't remove all the cancer, so she would have needed additional surgery with the radiation.
The couple opted instead for a mastectomy -- and removal of the other healthy breast.
Rancic said she went public to take the "stigma away" from the word mastectomy, which "seemed so scary" to her at first but was her ultimate decision after careful consultation with her doctors and other breast cancer patients.
Having not had the surgery yet, however, Rancic did give the impression that her recuperation would be swift, saying she hoped for a "full recovery by New Year's Eve." She also noted that she'd be having breast
reconstruction at the same time as the mastectomy, a procedure called immediate breast reconstruction.
As the American Cancer Society website states, "after the first surgery, there still may be a number of steps that are needed to complete the immediate reconstruction process. If you are planning to have immediate
reconstruction, be sure to ask what will need to be done afterward and how long it will take." In general, immediate reconstruction with its longer and more involved surgery requires a longer hospitalization
and more recuperation time than mastectomies alone, which could mean a few months, rather than a few
weeks, of pain and discomfort. And women who opt for mastectomies usually must cope with the loss of sexual sensations in their newly constructed breasts, an issue that gets little attention in this debate.
Other celebrities have also gone public with their decisions to have double mastectomies as preventive measures. Christina Applegate, who said she carried the BRCA-1 gene mutation, had the procedure several
years ago, and comedian Wanda Sykes more recently announced she had both her breasts removed after having a stage zero in situ cancer diagnosed in one breast.
For Applegate who carried a high risk of developing an aggressive tumor, a double mastectomy reduced her chances of getting breast cancer by about 90 percent. Both Sykes and Rancic said they preferred the more radical procedure to the anxiety of having twice yearly
mammograms to check for cancer. And both felt the surgery gave them a better shot at survival than alternatives like lumpectomy with radiation accompanied by regular screening. That's a notion disputed by
many research studies.
As I've said before and I'll say again, I do wonder how well doctors educate women on the pain and length of
time that goes into recuperation from a double mastectomy and reconstruction. I hope for Rancic's sake the she really does recover fully by New Year's, but if she doesn't, she may want to do yet another interview on the realities of breast reconstruction to help other women make informed decisions.
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