Why Do Many Younger Women Choose Mastectomy Over Lumpectomy?

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Early-stage breast cancer diagnosed in women age 40 and younger has a somewhat worse overall prognosis than early-stage breast cancer diagnosed in older women. Still, lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for younger women with an average risk of the cancer coming back (recurrence).

Recent research has shown that more and more young women diagnosed with early-stage breast cancer are choosing to have mastectomy instead of lumpectomy, possibly because they believe that the more aggressive surgery option might improve their overall prognosis. Still, doctors aren’t exactly sure why younger women are deciding to have mastectomy instead of lumpectomy plus radiation to treat early-stage breast cancer.

A small study has found a number of reasons why younger women opt for mastectomy, including having an abnormal BRCA1 or BRCA2 gene, the cancer being HER2-positive, and having more than two children.

The study, “Choosing mastectomy over lumpectomy: Factors associated with surgical decisions in young women with breast cancer,” was presented at the 2013 American Society of Clinical Oncology Annual Meeting.

The researchers evaluated 227 women ages 40 or younger diagnosed with early-stage breast cancer who said they had a choice between mastectomy and lumpectomy and radiation:

  • the women ranged in age from 17 to 40
  • 75% of the women were married
  • 90% had stage I or stage II breast cancer
  • 65% were diagnosed with estrogen-receptor-positive disease
  • 14% had an abnormal BRCA1 or BRCA2 gene

Most of the women (172, or 62%) decided to have either a single or double mastectomy.

The researchers found that the following factors were linked to a young woman having a mastectomy:

  • having an abnormal BRCA1 or BRCA2 gene
  • breast cancer in any lymph nodes
  • breast cancer that is HER2-positive
  • breast cancer that is considered higher grade
  • having two or more children
  • having a lower body mass index
  • anxiety about the breast cancer
  • a woman having more involvement in making the surgery decision

The following factors weren’t associated with having a mastectomy:

  • a woman’s age, race, or marital status
  • the size of the tumor
  • having a first degree relative diagnosed with breast or ovarian cancer
  • estrogen receptor status
  • fear of recurrence
  • depression

If you’ve been diagnosed with early-stage breast cancer, you and your doctor will discuss a surgical approach that makes the most sense for you and your unique situation. It's a good idea to ask your doctor about the cancer characteristics that are influencing the surgery recommendation. Your surgery decision also should reflect your personal beliefs and preferences. Accurate information about the cancer, as well as a clear understanding of what you want, are essential to developing a treatment plan that makes the most sense for you.

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