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Mastectomy Doesn’t Eliminate Need for Screening

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While research has shown that lumpectomy plus radiation offers the same survival rates as mastectomy for early-stage breast cancer, more U.S. women diagnosed with early-stage disease are choosing to have mastectomy instead of lumpectomy plus radiation. In some cases, women have said they opted for mastectomy to avoid having mammograms or biopsies of the remaining breast tissue in the future.

A study done at Mount Sinai Hospital in New York City suggests that having a mastectomy doesn’t completely eliminate the need for future breast imaging.

The research was published online on Sept. 10, 2018, by the Annals of Surgical Oncology. Read the abstract of “Defining the Need for Imaging and Biopsy After Mastectomy.”

To do the study, the researchers looked at the records of 385 women who had surgery to remove early-stage breast cancer between 2009 and 2015:

  • 185 women had single mastectomy
  • 200 women had double mastectomy; breast cancer was diagnosed in one breast, and the women chose to have the other healthy breast removed as well

About 8% of women ultimately had a biopsy after mastectomy. The women were followed for an average of 2.5 years.

Imaging and biopsies in women who had single mastectomy

During follow-up, rates of breast imaging or biopsy because of something found during a doctor’s breast exam among the 185 women who had single mastectomy were:

  • 19 women had ultrasound of the remaining breast tissue
  • 11 women had a biopsy

The results of the biopsies found that two women had a cancerous lesion.

Imaging and biopsies in women who had double mastectomy

During follow-up, rates of breast imaging or biopsy because of something found during a doctor’s exam among the 200 women who had double mastectomy were:

  • 29 women had breast ultrasound; 22 of these ultrasounds were done on the side where the cancer was
  • 2 women had breast MRI
  • 16 women had a biopsy; 11 of the biopsies were done on the side where the cancer was

The results of the biopsies done on the side where cancer was previously found more cancer in three women. The results of the five biopsies done on the opposite side were benign.

The researchers concluded that for 10% to 15.5% of women who have either single or double mastectomy, future breast imaging is required, and 6% to 8% ultimately have a biopsy. The good news is that the rate of malignancy was low, approximately 1%. Still, enough cases of cancer were found that the researchers concluded that mastectomies do not eliminate the need for future imaging and biopsy.

“Autonomy and choice in treatment are encouraged, and can be empowering for patients,” said Soojin Ahn, assistant professor of breast surgery at Mount Sinai and lead author of the study. “But decision-making can also result in anxiety, fear, and distress. Some patients might choose more extensive surgery with the hope that this will reduce the need for breast imaging and biopsy later, when in fact this is not necessarily the medically beneficial course.”

The researchers didn’t talk about other reasons a woman might opt for mastectomy over radiation plus lumpectomy. For example, the study didn’t say how many women had a BRCA1 or BRCA2 mutation. Having one of these genetic mutations 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 discuss how many women had a strong family history of breast cancer, which also would influence a woman’s surgery decision.

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. Ask your doctor about current recommendations for screening after breast cancer surgery. 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 Surgery section.

To talk with others about surgery for breast cancer, join the Discussion Board forum Surgery - Before, During, and After.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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