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More women choose prophylactic mastectomy [Updated]

September 28, 2009 |  8:00 am

The choice to remove a healthy breast in order to avoid breast cancer is a deeply personal decision that appears to be on the upswing in one group of women, according to a study published today in the journal 


Among women who had cancer in one breast, the number who opted to have  the other breast removed, called contralateral prophylactic mastectomy, increased from 1995 to 2005 in New York state. During the same time period, however, the number of healthy women who chose to have a prophylactic mastectomy of both breasts because of a higher-than-average risk of developing cancer held steady. The research is among the first to examine the choice of prophylactic mastectomy among women who did have cancer.
"We have about 100 women a year in New York who have prophylactic mastectomy without breast cancer," said the lead author of the study, Dr. Stephen B. Edge, a professor of surgery and oncology at Roswell Park Cancer Institute in Buffalo, N.Y. "That number hasn't changed despite the press coverage this subject gets and despite gene testing."
The practice of removing breasts to avoid cancer is most common among women with a strong family history of the disease and who test positive for the BRCA-1 or BRCA-2 gene mutation.
But, Edge says, there are no data "to demonstrate that having the prophylactic mastectomy actually improves your survival."
High-risk women considering this option should be evaluated by a multi-disciplinary team including a genetic counselor, he said.
Likewise, there is little evidence to support the recommendation that women with cancer in one breast have the healthy breast removed to improve survival. Yet the study found almost 5,000 New York women chose a contralateral prophylactic mastectomy during the 11-year period, with the number more than doubling from 1995 to 2005.
"It really increased dramatically," Edge said. "We are not making a value judgment that it is good or bad. But it's an important trend. . .The concern is that we have women doing this out of a gut reaction. No one is really counseling women in detail about their risk. They have a 10% to 15% chance of developing cancer in the other breast in 20 years. Most likely that cancer would be detected at a very early age. So does it warrant having the breast removed?"

The National Comprehensive Cancer Network, an alliance of top cancer centers, offers detailed guidelines about breast cancer treatment but offers little information on the option of bilateral prophylactic mastectomy, Edge said, perhaps leaving doctors and women with a lack of resources with which to base a decision.

[Updated 2:52 p.m.] The new study mirrors research published in 2007 that also found an increase in women nationwide, especially white women and younger women, choosing contralateral mastectomy.

"We're not exactly certain why we're seeing this trend," said Dr. Todd M. Tuttle, chief of the division of surgical oncology at the University of Minnesota and the author of the 2007 study. "One reason is that there is increased awareness of genetic risk and of gene testing. There has also been a marked improvement in mastectomy techniques and breast reconstruction techniques in the past decade in the United States."

But the trend also coincides with an increase in women who are choosing mastectomy instead of having a less-invasive lumpectomy to remove a breast tumor, Tuttle said.

"It's an oddity," Tuttle said. "Throughout surgery, there is such a huge push to do procedures that have less scarring, the shortest surgery, the shortest recovery. That is true for everything except breast cancer."

 -- Shari Roan
Photo: Participants at the 2008 Susan G. Komen Orange County Race for the Cure in Newport Beach. Credit: Allen J. Schaben / Los Angeles Times
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Comments (5)

Lieb,J."Defeating cancer with antidepressants." ecancermedicalscience DOI.10.3332/eCMS.2008.88. The fourth of five reviews published since 2001.
May be verified without human interference by accessing Medline or Pubmed, and entering "cancer" and "antidepressants."

In order to face the colon cancer the early detection it is the best strategy to maintain our health. Although the people are very few who practice it, or by negligence or ignorance. The colon cancer is the second cause of death by cancer in men, soon of the cancer of prostate, for that reason recommendable to be made one colonoscopía to detect this disease, findrxonline explains on this item. In many countries they do not take much importance on the early detection from diseases, Peru from long time precociously does not surpass the number of 10% of patients with detected cancer, is to say in stages in which this disease can be curable. In east Chile percentage arrives at 40% and in Japan it arrives at 60%.

I saw a study that this was higher among women physicians. Many women convince themselves they must have a genetic predisposition, the genes for which have not been discovered, and they want double mastectomy. Others are more likely to follow the standard more conservative treatment recommended by their physicians and surgeons based on long term followup results.
There is at least one group "Y Me" encouraging women to have double mastectomy.

Some surgeons don't charge any more for a double than a single and it spares the cost of lifelong followup mammograms.

Yes a disturbing trend but an understandable gut reaction. October is Breast Cancer Awareness month. Let us keep our focus on prevention and start by banning Atrazine and other harmful toxins that affect the reproductive organs.

I was diagnosed with stage I breast cancer 2.5 years ago, and chose bilateral mastectomy rather than the recommended lumpectomy for several reasons-- because I did not want the accompanying radiation; because an MRI two months earlier missed my cancer; due to overwhelming family history of early deaths due to cancer; and because I wanted to emerge from the process of reconstruction as symmetrical as possible. I do not carry a known BRCA mutation. While my choice does not improve my survival rate, it definitely greatly reduces my risk of a new primary cancer in the other breast.


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