This article appears in Paint it Pink 2017.
Women with early-stage cancer in one breast are increasingly choosing double mastectomies — even if they are at low risk of developing breast cancer in the other, healthy breast, a new study published in JAMA found.
Nearly half of women with early-stage breast cancer consider having a double mastectomy, and one in six received it.
“That one in six breast cancer patients chose bilateral mastectomy is really striking. We knew it was increasing, but I don’t think many of us realized just how frequent this is,” said study author Dr. Reshma Jagsi, professor and deputy chair of radiation oncology at the University of Michigan.
Myths and facts
The procedure is known as contralateral prophylactic mastectomy, in which the healthy breast is removed along with the cancerous breast. It’s an aggressive form of treatment that is recommended for women “who are at a very high risk of developing a new breast cancer” such as those with BRCA 1 or 2 mutations, family history or other risk factors, said Susan Brown, senior director of education and patient support for Susan G. Komen.
Especially concerning is the lack of knowledge about the procedure and its benefits, Brown said. Many women diagnosed with early-stage breast cancer decide on the most aggressive treatment with the belief that it will increase their rate of survival, Brown said.
“For a woman with average risk of developing a breast cancer in the second breast, a contralateral prophylactic mastectomy does not increase survival rates,” Brown said.
Among patients who considered double mastectomy, only 38 percent knew it does not improve survival for all women with breast cancer, the study found.
Other misinformation muddies the decision-making process. For example, some patients think having a mastectomy on a healthy breast will stop them from having to undergo chemotherapy or other targeted therapies, but that is not true, Brown said.
“Contralateral prophylactic mastectomy will only reduce the risk of breast cancer developing in the healthy breast, but it doesn’t reduce the risk of breast cancer returning in the original breast or coming back later in another part of the body,” Brown said.
What you need to know
“Every surgery we perform can have potential complications. These need to be discussed and need to be taken into account carefully before decisions are made,” said Dr. Virginia Kaklamani, a medical oncologist and head of the breast cancer program at University of Texas Health San Antonio.
It’s important to understand the risks and benefits of treatment and how likely treatment is to positively affect survival rates, Brown said.
There may also be post-operative complications, additional costs, and issues related to long-term suffering and quality of life, Brown said.
In the study, almost all patients said peace of mind motivated them to choose double mastectomy.
“They are afraid of another breast cancer, of more biopsies of going through this again,” Kaklamani said.
In these circumstances, a double mastectomy “can avoid years of anxiety and ongoing fears. For some women that’s a great benefit,” Brown said.