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. Research published in 2016 found that rates of prophylactic mastectomy more than tripled from 2002 to 2012, even though other studies have shown that removing the other healthy breast doesn’t improve survival.
A new study has found that nearly half of women diagnosed with early-stage breast cancer considered having a double mastectomy and one in six -- about 17% -- had the surgery, including many women who were at low risk of developing a second breast cancer.
The study was published online on Dec. 21, 2016 by JAMA Surgery. Read the abstract of “Contralateral Prophylactic Mastectomy Decisions in a Population-Based Sample of Patients With Early-Stage Breast Cancer.”
In the study, the researchers surveyed 2,402 women who were newly diagnosed with stage 0, stage I, or stage II breast cancer between July 2013 and September 2014. The researchers asked about:
- the women’s knowledge of contralateral prophylactic mastectomy
- why they chose the type of surgery they did
- the factors they considered when making their surgery decision
- the type of surgery, if any, their doctor recommended
- any discussions they had with their doctor about surgery
- Overall, 43.9% of the women considered contralateral prophylactic mastectomy and 24.8% considered it strongly or very strongly.
- Only 38.1% of the women knew that contralateral prophylactic mastectomy doesn’t improve survival for all women diagnosed with breast cancer. In most cases, removing the other healthy breast improves survival only for women at high risk of a second breast cancer: women with a genetic mutation linked to breast cancer, such as an abnormal BRCA1 or BRCA2 gene, or women with a strong family history of the disease.
- Almost all the women said peace of mind motivated them to choose contralateral prophylactic mastectomy.
- Overall rates of surgery by type were:
- 61.6% lumpectomy
- 21.2% single mastectomy
- 17.3% contralateral prophylactic mastectomy
The researchers found that certain factors were linked to a higher likelihood of a woman having contralateral prophylactic mastectomy, including:
- being younger
- being white
- having more education
- having a family history of breast cancer
- having private insurance
About 65% of the women did not have a genetic mutation linked to breast cancer:
- Among these women, 39.3% said their surgeon recommended against contralateral prophylactic mastectomy; about 2% of these women had contralateral prophylactic mastectomy anyway.
- Among the 46.8% of these women who got no recommendation for or against contralateral prophylactic mastectomy, 19% decided to have contralateral prophylactic mastectomy.
"That one in six breast cancer patients chose bilateral mastectomy is really striking," said study author Reshma Jagsi, M.D., professor and deputy chair of radiation oncology at the University of Michigan. "We knew it was increasing, but I don't think many of us realized just how frequent this is.
"At a time when emotions are running high, it's not surprising that newly diagnosed breast cancer patients might find it difficult to absorb this complex information. It seems logical that more aggressive surgery should be better at fighting disease -- but that's not how breast cancer works. It's a real communication challenge," she added. "As physicians, we want to be respectful of our patients' preferences and values. We don't want to alienate patients who are already in a stressful situation. We want them to trust us. When a patient comes in saying she has already decided on double mastectomy, it can be challenging to strike that balance between respecting her preferences and adequately conveying why the medical community in general doesn't think it's necessary."
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 Breastcancer.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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