Prophylactic Mastectomy Rates Have More Than Tripled in Past Decade

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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 -- a double mastectomy. Removing the other healthy breast is called contralateral prophylactic mastectomy.

The healthy breast usually is removed because of an understandable fear that a new, second breast cancer might develop in that breast. More and more women who’ve been diagnosed are opting for contralateral prophylactic mastectomy -- in the late 1990s, between 4% and 6% of women who were having mastectomy decided to have the other healthy breast removed.

A study has found that rates of contralateral prophylactic mastectomy more than tripled from 2002 to 2012 even though studies have shown that removing the other healthy breast doesn’t improve survival.

The research was published online on March 11, 2016 by the Annals of Surgery. Read the abstract of “Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer.”

It’s important to know that a double mastectomy is a bigger operation than a single mastectomy or a lumpectomy. The recovery is longer and more difficult, and the risk of complications is higher.

It’s also important to know that research has found that women diagnosed with early-stage breast cancer in one breast who are treated with lumpectomy followed by radiation therapy have the same survival rates as women who are treated with double mastectomy.

The researchers used the SEER database to identify 496,488 women diagnosed with stage I to stage III breast cancer in one breast from 1998 to 2007. Overall:

  • 59.6% of the women had lumpectomy plus radiation
  • 33.4% had single mastectomy
  • 7.0% had contralateral prophylactic mastectomy

The women were followed until 2012.

The rate of women having contralateral prophylactic mastectomy rose from 3.9% in 2002 to 12.7% in 2012 -- so the rate, while still relatively low, more than tripled.

When the researchers compared survival statistics for women who had lumpectomy plus radiation and women who had prophylactic mastectomy, there was little to no difference.

The researchers said contralateral prophylactic mastectomy may be a good choice for high-risk women -- women with a BRCA1 or BRCA2 mutation, a strong family history of breast or ovarian cancer, or women who were treated with radiation to the chest as children.

The researchers also pointed out that more and more younger women are choosing contralateral prophylactic mastectomy over lumpectomy plus radiation, but only about a third of these women have one or more of the factors that would put them at high risk for breast cancer.

Other research suggests that a desire to make the breasts as symmetrical as possible and improve their overall appearance through reconstruction may be influencing many women’s decisions to have contralateral prophylactic mastectomy. The researchers found that rates of reconstruction in women who had contralateral prophylactic mastectomy increased from 35.3% to 55.4% during the study.

"Our analysis highlights the sustained, sharp rise in popularity of contralateral prophylactic mastectomy while contributing to the mounting evidence that this more extensive surgery offers no significant survival benefit to women with a first diagnosis of breast cancer," said senior author Mehra Golshan, M.D., distinguished chair in surgical oncology at Brigham and Women’s Hospital. "Patients and caregivers should weigh the expected benefits with the potential risks of contralateral prophylactic mastectomy, including prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and effects on self-image."

"Women with unilateral breast cancer undergoing contralateral prophylactic mastectomy continue to report a desire to extend life as one of the most important factors leading to their surgical decision," added Dr. Golshan. "Understanding why women choose to undergo contralateral prophylactic mastectomy may create an opportunity for health care providers to optimally counsel women about surgical options, address anxieties, discuss individual preferences, and ensure peace of mind related to a patient's surgical choice."

When you’re first diagnosed with breast cancer, fears about the future can affect how you make decisions. This is especially true for women who have an abnormal breast cancer gene or who have watched a mother or sister be diagnosed with breast cancer. You have to make a number of decisions at a very emotional time when it can be hard to absorb and understand all the new information you’re being given.

At Breastancer.org, we support every woman’s right to make treatment decisions based on the characteristics of the cancer she’s been diagnosed with, her medical history, her risk of recurrence or a new breast cancer, and her personal preferences. But it’s very important to make sure you understand all the pros and cons of any treatment or procedure you’re considering, including how the treatment or procedure may affect your reconstruction options and if the treatment is likely to make you live longer.

If you’ve been diagnosed with early-stage breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Contralateral prophylactic mastectomy is only one of these options and is an aggressive step. While it may be the right decision for you, give yourself the time you need to consider the decision carefully. It’s a good idea to talk to your doctor about how the details in your pathology report may affect your future risk. You want to be sure that your decisions are based on your actual risk of recurrence or a new cancer. Make sure you understand the benefits and risks of all your options. Together, you and your doctor can make the choices that are best for you and your unique situation.



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