The research study reviewed here found that between the years 1995 and 2005 the number of women choosing to have a healthy breast removed to minimize future breast cancer risk has been increasing. When a mastectomy is done to reduce the risk of future breast cancer, the surgery is called prophylactic mastectomy. When a mastectomy is done to remove a breast cancer, the surgery is called therapeutic mastectomy. These research findings agree with those from other studies looking at trends in prophylactic mastectomy.
The researchers reviewed the medical records of nearly 70,000 women from New York state who had mastectomies performed during the years 1995 through 2005. Overall during all 11 years, nearly 9% of these mastectomies were prophylactic mastectomies. The rest were therapeutic mastectomies. But the researchers found that the proportions of prophylactic and therapeutic mastectomies changed over the course of these 11 years.
Most women who have prophylactic mastectomy choose to do so after being diagnosed with early breast cancer in one breast. In this study, 81% of the prophylactic mastectomies were performed in women who had been diagnosed with breast cancer in the opposite breast. To minimize their risk of a recurrence in the same breast or the future development of a new breast cancer in the same or opposite breast, these women chose to have both breasts removed -- therapeutic for the breast with the cancer, and prophylactic for the opposite, healthy breast. Much less commonly, women who have never been diagnosed with breast cancer but are, or believe they are, at high risk for breast cancer choose to have both breasts removed prophylactically, to minimize their risk of ever developing breast cancer. Having both breasts removed is called bilateral mastectomy. In this study, 19% of the prophylactic mastectomies (bilateral) were performed in women who had never been diagnosed with breast cancer.
In this research, much of the increase in prophylactic mastectomies was among women who had already been diagnosed with breast cancer, but year after year a small number of women chose to have bilateral prophylactic mastectomy even though they had not ever been diagnosed with breast cancer.
The researchers found that prophylactic mastectomy was more commonly chosen by younger women, and by women who were Caucasian and who had private insurance. They speculated that the actual numbers of prophylactic mastectomies might actually have been higher than what they observed in their study, since in some cases prophylactic mastectomies may have been recorded as therapeutic. Some insurance companies will cover therapeutic, but not prophylactic, mastectomy.
This study didn't pinpoint why, over time, more women are choosing prophylactic mastectomy. For women already diagnosed with breast cancer it's likely they chose this surgery because they were concerned about developing breast cancer in the other breast. Being diagnosed with breast cancer does increase the risk of developing a new, different breast cancer in the future. For women who've been diagnosed with breast cancer but 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).
For the women in this study who had not ever been diagnosed with breast cancer, they presumably chose to have bilateral prophylactic mastectomy based on knowing -- or believing -- that their breast cancer risk is significantly increased (for example, based on family history and/or genetics).
Every woman diagnosed with breast cancer and every woman who is considered at high risk for breast cancer has to ask herself this question: for me, how much risk is enough to make a decision to remove one or both healthy breasts? Because each woman's situation is unique, every woman will have a different answer to the question.
Whether or not you have been diagnosed with breast cancer, if you're considering prophylactic mastectomy to reduce future risk, here are some things 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.
Although prophylactic mastectomy is still relatively rare, the proportion of women with breast cancer who opt to have the unaffected breast removed appears to be rising, researchers said.
In a study based on data from New York state, the number of women opting for contralateral prophylactic mastectomy more than doubled over an 11-year period, according to Stephen Edge, MD, of the Roswell Park Cancer Institute in Buffalo, and colleagues.
The rate among women without a history of breast cancer also rose, but not as dramatically, the researchers reported online in Cancer.
Over the same period, the number of therapeutic mastectomies in the state fell, so that the proportion of prophylactic procedures rose from 5.6% in 1995 to 14.1% in 2005, the researchers said.
All told, 69,831 women in New York had mastectomies over the 11 years from 1995 through 2005, including 63,556 for therapeutic reasons and 6,275 for prophylaxis, they said.
The findings come from an analysis of statewide discharge records, combined with data from New York's cancer registry.
"Although the total number of prophylactic mastectomies performed per year was small, it appears that the use of the surgery is increasing," Edge said in a statement.
The researchers found that 81% of the women who opted for a prophylactic mastectomy had a personal history of breast cancer, including 84% with invasive disease and 16% with ductal carcinoma in situ.
The remaining 19% (including women with lobular carcinoma in situ) had no identifiable personal history of breast cancer.
Most of the mastectomies (MedPage Today) -- 5,722 of 6,275 -- were bilateral, regardless of the reason for the procedure, the researchers found.
Overall, the number of prophylactic mastectomies increased over the study period, but most of the rise was among women with a history of cancer, they found.
Specifically:
Women undergoing prophylactic mastectomy tended to be young, the researchers said, and those with breast cancer who had a contralateral mastectomy were much younger than the average woman with breast cancer -- 49 versus 61.
Those who opted for prophylactic mastectomy were also more likely to be white and to have private insurance, they found.
The researchers noted that "without surveillance data regarding prophylactic mastectomies, it is difficult to address the extent to which practice patterns vary within the U.S. and worldwide."
They also noted that it's possible that the number of prophylactic mastectomies is actually higher than it appeared because of possible underutilization of the diagnosis code for that procedure. The reason for possible undercoding, they said: because insurance companies don't always pay for such procedures.
Although prophylactic mastectomy is still relatively rare, the proportion of women with breast cancer who opt to have the unaffected breast removed appears to be rising, researchers said.
In a study based on data from New York state, the number of women opting for contralateral prophylactic mastectomy more than doubled over an 11-year period, according to Stephen Edge, MD, of the Roswell Park Cancer Institute in Buffalo, and colleagues.
The rate among women without a history of breast cancer also rose, but not as dramatically, the researchers reported online in Cancer.
Over the same period, the number of therapeutic mastectomies in the state fell, so that the proportion of prophylactic procedures rose from 5.6% in 1995 to 14.1% in 2005, the researchers said.
All told, 69,831 women in New York had mastectomies over the 11 years from 1995 through 2005, including 63,556 for therapeutic reasons and 6,275 for prophylaxis, they said.
The findings come from an analysis of statewide discharge records, combined with data from New York's cancer registry.
"Although the total number of prophylactic mastectomies performed per year was small, it appears that the use of the surgery is increasing," Edge said in a statement.
The researchers found that 81% of the women who opted for a prophylactic mastectomy had a personal history of breast cancer, including 84% with invasive disease and 16% with ductal carcinoma in situ.
The remaining 19% (including women with lobular carcinoma in situ) had no identifiable personal history of breast cancer.
Most of the mastectomies (MedPage Today) -- 5,722 of 6,275 -- were bilateral, regardless of the reason for the procedure, the researchers found.
Overall, the number of prophylactic mastectomies increased over the study period, but most of the rise was among women with a history of cancer, they found.
Specifically:
Women undergoing prophylactic mastectomy tended to be young, the researchers said, and those with breast cancer who had a contralateral mastectomy were much younger than the average woman with breast cancer -- 49 versus 61.
Those who opted for prophylactic mastectomy were also more likely to be white and to have private insurance, they found.
The researchers noted that "without surveillance data regarding prophylactic mastectomies, it is difficult to address the extent to which practice patterns vary within the U.S. and worldwide."
They also noted that it's possible that the number of prophylactic mastectomies is actually higher than it appeared because of possible underutilization of the diagnosis code for that procedure. The reason for possible undercoding, they said: because insurance companies don't always pay for such procedures.
Primary source: Cancer Source reference: McLaughlin CC, et al "Surveillance of prophylactic mastectomy: Trends in use from 1995-2005" Cancer 2009; DOI: 10.1002/cncr.24623.
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