More Women Choosing 'Preventive' Double Mastectomy

MONDAY Oct. 22, 2007 -- Women diagnosed with breast cancer who have a mastectomy are increasingly choosing to have their other, healthy breast removed as a preventive measure.

The rate of the procedure, called a contralateral prophylactic mastectomy, more than doubled from 1998 to 2003, according to a new study.

The increase concerns study lead author Dr. Todd Tuttle, chief of surgical oncology and associate professor of surgery at the University of Minnesota Medical School. He believes many women may be making the choice for inappropriate reasons, and removing the other breast may be unnecessary.

"We don't know why women are choosing this," he said. "If they are choosing it because they think it will improve their breast cancer survival, I am very concerned. It won't improve their overall survival."

Research has failed to show a survival benefit with the second mastectomy, Tuttle said in his report, published online Oct. 22 in the Journal of Clinical Oncology. The reason: The risk of cancer spread from the original breast to other body sites often exceeds the risk of getting cancer in the second breast, he said.

Tuttle and his colleagues evaluated 4,969 women who chose contralateral prophylactic mastectomy, looking at the Surveillance, Epidemiology and End Results (SEER) database. From 1998 to 2003, the rate of preventive mastectomy for the second, healthy breast increased from 4.2 percent to 11 percent. Those most likely to choose the preventive operation were younger women and non-Hispanic whites.

Tuttle said there are times when a second mastectomy is appropriate. "I will tell patients to consider it strongly if they have a known genetic mutation -- BRCA1 or 2 [the so-called breast cancer genes] -- or a very strong family history, such as first-degree relatives who develop breast cancer before age 50," he said.

"Sometimes, we will recommend it in those who need mastectomy on one side and because of body symmetry issues, the other breast would be too big" once the cancerous breast is removed, he added.

Tuttle's advice is in line with advice from the Society of Surgical Oncology and the American Cancer Society. Many women overestimate their risk of getting cancer in the second breast, according to the Society of Surgical Oncology.

In March, a study led by researchers at Wake Forest University found that most women diagnosed with breast cancer who also chose to have their unaffected breast removed said they didn't regret their decision. And they said their quality of life equaled that of women who chose not to have a preventive mastectomy, according to the study in the Journal of Clinical Oncology.

Dr. S. Eva Singletary, professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston, said the increase in requests for the preventive mastectomies found in the new study "rings true clinically" for her patient population.

Singletary credits the increase in second mastectomies to "an improvement in breast reconstruction techniques," among other factors. Women who opt for immediate reconstruction after a mastectomy may be more likely to choose contralateral mastectomy and get the second breast reconstructed at the same time, sometimes to achieve better symmetry, particularly if they are heavy, she said.

In another study, published last week in the American Journal of Epidemiology, researchers reported that increased exposure to sunlight, which boosts vitamin D levels, may reduce the risk of advanced breast cancer in light-skinned women.

The study compared 1,788 breast cancer patients in San Francisco with a control group of 2,129 women who did not have breast cancer. The study participants had a wide range of natural skin colors. Vitamin D may help slow breast cancer cell growth, the researchers speculated. But the results aren't an endorsement to sunbathe. Instead, they said, vitamin D from diet and supplements may someday be recommended to help reduce breast cancer risk.

More information

To learn more about contralteral prophylactic mastectomy, visit The Society of Surgical Oncology.

Posted: October 2007


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