A large study (more than 150,000 patient histories were reviewed) found that more women chose to have both breasts removed -- even though cancer had been found in only one breast -- between 1998 and 2003. Surgery to remove both breasts is called double or bilateral mastectomy.
The study didn't pinpoint why more women are choosing double mastectomy. But it's likely the women chose this surgery because they were concerned about developing breast cancer in the other breast. Being diagnosed with breast cancer increases the risk of developing a new, different breast cancer in the future.
For women who don't have an abnormal BRCA1 or BRCA2 gene, the risk of developing a new breast cancer in the other breast is about 1% a year. After 10 years, this risk is about 10%. For women who have an abnormal BRCA1 or BRCA2 gene, the risk of developing a new breast cancer in the other breast is higher. Their risk can be 3 to 4% per year (30% to 40% over 10 years).
Every woman diagnosed with breast cancer has to ask herself this question: for me, how much risk is enough to make a decision to remove a healthy breast after cancer has affected my other breast?
Because each woman's situation is unique, every woman will have a different answer to the question.
Double mastectomy is more common among younger women and among women who have been diagnosed twice with breast cancer. Younger women have more time ahead of them to possibly develop a second breast cancer. Women diagnosed with breast cancer more than once are understandably concerned about being diagnosed yet again, even if they don't have an abnormal BRCA1 or BRCA2 gene.
If you're considering double mastectomy to reduce future risk, here are some things to consider:
- What's your real risk of developing a second breast cancer? This is an important discussion to have with your doctor. Generally speaking, women tend to overestimate their risk of breast cancer. This may be an unintended effect of greater breast cancer awareness. Before making any decisions about surgery, it's worth taking the time to understand your unique situation and the risk associated with it. This allows you to base your decision on facts.
- What are your plans, if any, for breast reconstruction after surgery? To achieve a balanced appearance, some women may need or want cosmetic surgery on the healthy breast after reconstruction. Also, some types of reconstruction may be performed only once. This could limit reconstruction choices for women who may need a second mastectomy if breast cancer is diagnosed in the future in the other breast. Because of this, some women may opt to have a double mastectomy and reconstruct both breasts at the same time. Your medical team, including a plastic surgeon, can help you make the decision that's best for you.
- Do you have an abnormal BRCA1 or BRCA2 gene? Some women may make decisions assuming they have an abnormal gene because someone in their family had breast cancer -- without having genetic testing and counseling themselves. Having an abnormal BRCA1 or BRCA2 gene makes a big difference in the risk of developing a future breast cancer. If you're considering a double mastectomy because you MIGHT have an abnormal gene based on family history, talk to your doctor about whether genetic testing and counseling are right for you. You may still decide to have a double mastectomy, but it's better to make that decision based on facts, not assumptions.
- Can medicine lower my risk of a future breast cancer? Removing a healthy breast essentially eliminates the possibility of future breast cancer in that breast. Medicines that lower the risk of breast cancer don't offer the same certainty, but they're another option to consider.
Talk to your medical team about all your options and make your decisions based on the best information available for YOU and your unique situation.