More Women Choose to Remove Noncancerous Breasts
Study: Prophylactic Mastectomy Increasing as Acceptance of Procedure Grows
By
Shahreen Abedin
WebMD Health News
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.
Stephen B. Edge, MD, FACS, chairman, department of breast surgery, Roswell Park Cancer Institute; professor of surgery, University at Buffalo School of Medicine & Biomedical Sciences.
Rache Simmons, MD, FACS, professor of surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center.
Stephen F. Sener, MD, FACS, spokesman and past president, American Cancer Society; chief, division of surgical oncology, Keck School of Medicine, University of Southern California.
American Cancer Society.
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