More U.S. Women Choosing Mastectomy Over Lumpectomy for Early-Stage Disease

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Many studies done in the 1970s showed that lumpectomy plus radiation to treat women diagnosed with early-stage breast cancer offered the same survival rates as mastectomy. Based on these studies, the U.S. National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation was preferred over mastectomy to treat early-stage breast cancer.

Still, 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. So while a woman has cancer in just one breast, she has a double mastectomy.

The healthy breast is usually removed because of an understandable fear that a new, second breast cancer might develop in that breast.

Earlier studies suggest that more women, especially younger women, diagnosed with early-stage breast cancer in one breast are choosing to have the breast affected by cancer as well as the other healthy breast removed.

Most of this earlier research looked at regional trends. In this study, the researchers looked at information from across the United States to see if the shift to mastectomy or double mastectomy instead of lumpectomy for women diagnosed with early-stage disease was nationwide.

The researchers found that in the past 10 years more U.S. women diagnosed with early-stage breast cancer who were eligible for lumpectomy chose mastectomy or double mastectomy followed by reconstruction.

The study was published online on Nov. 19, 2014 by JAMA Surgery. Read “Nationwide Trends in Mastectomy for Early-Stage Breast Cancer."

The researchers looked at the medical records of more than 1.2 million women diagnosed with early-stage breast cancer in one breast and treated at centers across the United States from 1998 to 2011. The records are part of the National Cancer Data Base, a nationwide database created by the American Cancer Society and the American College of Surgeons Commission on Cancer.

The researchers found that:

  • 35.5% of the women had mastectomy
  • 64.5% of the women had lumpectomy

Among the women who had mastectomy:

  • 45.0% had total mastectomy (the entire breast is removed, but no muscle beneath the breast is removed and lymph nodes usually aren’t removed)
  • 34.7% had modified radical mastectomy (the entire breast and underarm lymph nodes are removed, but no muscle beneath the breast is removed)
  • 19.5% had double mastectomy
  • 0.8% had radical mastectomy (the entire breast, underarm lymph nodes, and chest wall muscles are removed)

Compared to women who had lumpectomy, women who had mastectomy were more likely to:

  • be younger
  • be white
  • have other health problems
  • not have insurance
  • live in the South
  • have less education
  • be diagnosed with invasive cancer rather than DCIS
  • have positive lymph nodes

The percentage of women who were eligible to have lumpectomy but chose mastectomy went from 34.2% in 1998 to 37.8% in 2001.

In women who had mastectomy, reconstruction rates increased from 11.6% in 1998 to 36.4% in 2011.

Double mastectomy rates went up from 1.9% in 1998 to 11.2% in 2011.

The increase in mastectomy rates was highest among:

  • younger women diagnosed with DCIS
  • women diagnosed with smaller cancers
  • women with negative lymph nodes

These cancer characteristics -- being non-invasive, being smaller, and having no cancer in the lymph nodes -- means the cancer is less likely to spread or come back (recurrence). So the researchers think that a number of other factors besides controlling the cancer are influencing women’s -- especially younger women’s -- surgery decisions.

The National Accreditation Program for Breast Centers requires that all women having mastectomy be offered reconstruction. Also, the Women’s Health and Cancer Rights Act, passed in 1998, requires reconstruction after mastectomy be covered by insurance.

The researchers didn’t know how many of the women in the study had an abnormal BRCA1 or BRCA2 gene. Having one of these abnormal genes greatly increases a woman’s lifetime risk of breast and ovarian cancer and may influence a woman’s decision to have mastectomy or double mastectomy rather than lumpectomy. The researchers also didn’t know how many women had a strong family history of breast cancer, which also would influence a woman’s surgery decision.

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

Some doctors are concerned that too many women diagnosed with early-stage breast cancer in one breast are choosing mastectomy or double mastectomy because they overestimate their risk of future breast cancer. Mastectomy and double mastectomy are bigger operations than lumpectomy. Recovery can be more difficult and there’s a higher risk of complications.

If you've been diagnosed with early-stage breast cancer in one breast, ask your doctor about ALL of your treatment and risk reduction options. Mastectomy and double mastectomy are aggressive steps. While one of those surgeries 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.

For more information on the types of surgery used to remove breast cancer, visit the Breastcancer.org Surgery section.


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