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. Statistics show that more and 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.
Because of the increase in prophylactic contralateral mastectomies, researchers wanted to know if the extra surgery was benefiting women.
A study suggests 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 research was published in the September 2014 issue of The Journal of the American Medical Association. Read “Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011.”
The researchers looked at the medical records of 189,734 California women who were diagnosed with early-stage breast cancer in one breast from 1998 to 2011.
During that time, the overall number of women who chose to have double mastectomy increased from 2% in 1998 to 12.3% in 2011. This increase was even larger in women younger than 40:
- 3.6% of these younger women had double mastectomy in 1998
- 33% of these younger women had double mastectomy in 2011
Overall, the researchers found:
- 55% of the women were treated with lumpectomy followed by radiation therapy
- 38.8% were treated with single mastectomy
- 6.2% were treated with double mastectomy
The researchers then looked at the 10-year survival rates of the three treatments groups:
- 83.2% of women who had lumpectomy plus radiation were alive 10 years after diagnosis
- 81.2% of women who had double mastectomy were alive 10 years after diagnosis
- 79.9% of women who had single mastectomy were alive 10 years after diagnosis
The small difference in survival rates between the women who had lumpectomy plus radiation and the women who had double mastectomy wasn’t statistically significant, which means it could have happened by chance and wasn’t because of the difference in treatment.
"We can now say that the average breast cancer patient who has bilateral mastectomy will have no better survival than the average patient who has lumpectomy plus radiation," said Allison Kurian, assistant professor of medicine and of health research and policy at Stanford, who was the study’s lead author. "Furthermore, a mastectomy is a major procedure that can require significant recovery time and may entail breast reconstruction, whereas a lumpectomy is much less invasive with a shorter recovery period."
The researchers said the slightly lower survival rate among women who were treated with single mastectomy could be because these women may have been more likely to have other health problems, such as diabetes, that could have affected the length or effectiveness of their breast cancer treatments. They also may have had problems accessing care, including having a hard time finding a ride to radiation treatment appointments.
This study is reassuring and offers more evidence that lumpectomy followed by radiation is just as effective as mastectomy (or double mastectomy) to treat early-stage breast cancer in one breast.
Still, if you are at a higher-than-average risk of breast cancer because:
- you know you have an abnormal gene linked to breast cancer, including BRCA1, BRCA2, or PALB2
- you have a strong family history of breast cancer among more than one first-degree relative, such as a mother, sister, or daughter
then a double mastectomy might make sense for you.
Women who don’t have either 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 are choosing to have contralateral prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer. Double mastectomy is a bigger operation. It’s associated with a more difficult recovery and more 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. Double mastectomy is only one of these options and is an aggressive step. While that 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 procedures that remove breast cancer, visit the Breastcancer.org Surgery section.
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