Fear Pushes Many Women to Choose Double Mastectomy

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Some women who've been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed. Removing the other healthy breast is called contralateral prophylactic mastectomy, or double mastectomy.

The healthy breast usually is removed because of understandable fear that a new, second breast cancer might develop in that breast. But, according to a new study, most women who choose to have both breasts removed face a very low risk of developing cancer in the healthy breast.

The study, “Is contralatereal prophylactic mastectomy (CPM) overused? Results from a population-based study,” was presented at the American Society of Clinical Oncology’s 2012 Quality Care Symposium.

Between 2005 and 2007, the researchers surveyed more than 2,000 women after they were diagnosed with early-stage breast cancer. They repeated the survey 4 years later with 1,525 of the original participants. At this follow-up, they found:

  • 1,446 women hadn’t had a recurrence of breast cancer.
  • 35% said they’d considered double mastectomy, and 7% had chosen to have the procedure.
  • Women who’d had mastectomy instead of lumpectomy to remove the original cancer were the most likely to consider double mastectomy and have it done. Of the 564 women who’d had a mastectomy, 53% said they’d considered double mastectomy, and 19% had chosen to have it.

The women’s worries about recurrence (the cancer coming back), rather than their actual recurrence risk, was one of the biggest factors behind the decision to have both breasts removed.

Among the women who chose double mastectomy, about 80% didn’t meet the generally used risk assessment standards for double mastectomy. The standards, developed by the Society of Surgical Oncology, include:

  • having an abnormal BRCA1 or BRCA2 gene
  • a family history of breast cancer among more than one first-degree relative, such as a mother, sister, or daughter

Women who don’t have either of these increased risk factors are very unlikely to develop a second cancer in the healthy breast. (Their risk is 1% or less per year.)

Some doctors are concerned that too many women are choosing to undergo contralateral prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer. Double mastectomy is a bigger operation. It’s associated with a harder recovery and more complications.

If you've been diagnosed with breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Double mastectomy is only one of these options and is an aggressive step. While that may be the right decision for you, give yourself the time you need to consider your decision carefully. Talk to your doctor to make sure that your decisions are based on your actual risk. Ask your doctor about how the cancer details in your pathology report may affect your future risk. Together, you and your doctor can make the decisions that are best for you and your unique situation.

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