From Our 2009 Archives
More Women Choose to Remove Noncancerous Breasts
Study: Prophylactic Mastectomy Increasing as Acceptance of Procedure Grows
Reviewed By Louise Chang, MD
Sept. 28, 2009 -- In the first study to define how many American women are undergoing prophylactic mastectomy, researchers have found that the number of women choosing to have the protective procedure is on the rise.
Prophylactic mastectomy is the removal of a healthy breast in order to reduce risks of developing breast cancer. According to the study's results, the number of patients in New York State who had a healthy breast removed after a cancer diagnosis more than doubled between 1995 and 2005, even though the total number of women having mastectomies dropped by one-third. The rate of women who underwent the procedure without having any breast cancer at all only rose slightly during this period.
"It's true that women who decide to have prophylactic mastectomies end up with a 'virtually zero' risk of having breast cancer. But my patients say, 'It's not even the medical issue; it's the anxiety.' They just don't want to worry about getting it in the other breast some day," explains breast cancer surgeon Rache Simmons, MD, FACS, of New York-Presbyterian Hospital/Weill Cornell Medical Center. "I have never had a patient regret that decision," says Simmons, who was not involved in the study.
Simmons estimates that she performs 10 times as many double mastectomies in patients with one non-cancerous breast than she did 10 years ago. Part of the reason: the much wider availability and awareness of genetic testing for the BRCA1 and BRCA2 mutations, she tells WebMD. These gene mutations are associated with an 85% lifetime risk of developing breast cancer and a much higher chance of tumors appearing in both breasts, according to the American Cancer Society.
Greater social acceptance of double mastectomies and improved cosmetic surgery techniques are additional reasons for the growing numbers, says Simmons.
Of the 6,275 women who had prophylactic mastectomy in the study, 81% of them had been diagnosed with cancer in one breast. The rest had no personal history of breast cancer, suggesting they had high risk factors for breast cancer such strong family history and positive BRCA test results.
Prophylactic Mastectomy: No Improvement in Survival Rate
Despite dramatically lowering chances of future breast cancers from developing, prophylactic breast removal has not been shown to cut down a woman's chances of dying from breast cancer – a distinction that study author Stephen B. Edge, MD, FACS makes to caution patients against choosing the surgery without careful consideration.
"Unfortunately, the cold hard fact is that the threat to their life comes from the cancer that they already have," says Edge, who heads the department of breast surgery at Roswell Park Cancer Institute in Buffalo. He remarks that he is heartened to find it still relatively uncommon for women with no past breast cancers to undergo double mastectomies, in light of recent media coverage of celebrities who choose the dramatic procedure.
Women who are considering removing a healthy breast should weigh the pros and cons with the help of counseling in a breast cancer program that includes specialists in genetics, advises Edge. "People usually make good decisions when they're well-informed," he says.
Both Simmons and Edge agree that the best candidate for prophylactic removal of both breasts is a BRCA-positive woman who also has a strong family history of the disease, meaning she has several first- and second-degree relatives who were diagnosed at a young age.
The current study, published in the Sept. 28 online edition of the journal Cancer, used cancer data collected from New York state health records. The results showed that women who underwent double mastectomy to protect against further cancer development were more likely to be younger, white, and carry private health insurance than other breast cancer patients.
Edge attributes the overall drop in mastectomy rates seen over the past two decades in the study to the high success rate of surgical lump removal -- a less invasive, relatively conservative approach compared to extracting the entire breast. He says that lumpectomy yields a survival rate similar to mastectomy.
SOURCES: McLaughlin, C. Cancer, published online Sept. 28, 2009.
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