More Women Having Other Breast Removed
MONDAY Sept. 28, 2009 -- Many more women are deciding to have a healthy breast removed after being diagnosed with breast cancer in the other.
But there's little evidence to suggest that this practice is actually beneficial in terms of improving survival, say the authors of a study published Sept. 28 in Cancer.
The researchers, led by Dr. Stephen B. Edge, director of the Breast Center at the Roswell Park Cancer Institute in Buffalo, N.Y., set out to determine how often women elected to undergo prophylactic mastectomy in New York between 1995 and 2005. Prophylactic removal of a non-cancerous breast or the ovaries and anti-estrogen therapy can reduce a woman's risk for developing breast cancer, according to the study's authors.
In women with a diagnosis of breast cancer, the rate for removal of the opposite breast, known as contralateral mastectomy, more than doubled during that time period, from 5.6 percent in 1995 to 14.1 percent in 2005.
But the procedure is still uncommon, the authors noted, estimating that about 1.9 percent of women with breast cancer diagnosed in 1995 or 1996 had a contralateral mastectomy, compared with 4.2 percent a decade later.
Women who had a preventive mastectomy in the other breast tended to be younger than the average age for women who had a therapeutic mastectomy (49 versus 61 years). They were also more likely to be white and to hold private insurance than were other women with breast cancer.
"There's not much evidence that contralateral prophylactic mastectomy will benefit survival," said Dr. Shawna Willey, chief of breast surgery and director of the Betty Lou Ourisman Breast Health Center at the Lombardi Comprehensive Cancer Center at Georgetown University Hospital in Washington, D.C. "For a woman, it's often a knee-jerk emotional reaction when they're told they have breast cancer, especially if they're told they need to have a mastectomy."
Women who require a mastectomy are more likely to also need chemotherapy and radiation. "They're facing a lot of treatment, and they're thinking they just don't want to deal with this in the future," she said.
On the other hand, the rate of preventive mastectomies in women without a diagnosis of breast cancer but with a strong family history of the disease has stayed relatively low and stable over the past 10 years, the study found. The evidence of a benefit of prophylactic removal of a breast is more robust in this group of women.
The study also found that the overall rate of mastectomy as a treatment for breast cancer is going down.
The findings echo a study from 2007, which found that the rate of contralateral prophylactic mastectomy more than doubled from 1998 to 2003. That paper noted that the procedure is often inappropriate and unnecessary.
That trend "tends to be a little concerning," said Edge, who is a professor of surgery and oncology at the New York cancer institute. "It's going up an awful lot, with probably little value, and it's a big deal -- a big operation. It's not trivial."
For doctors, the findings point out that "we need to redouble our efforts to counsel women," he said.
Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La., said that "getting unnecessary surgery is expensive, and a lot of women who have this done tend to have post-operative complications and tend to delay the treatment of their primary cancer," said
One reason for the increase, he said, was that more women are getting MRIs, which pick up many "spots" in the breast, most of which mean nothing.
But the study leaves many questions unanswered, Willey said.
"It doesn't tell you what the motivating force was," she said. "Were physicians recommending this, or were patients choosing it? Were some of these prophylactic mastectomies done for symmetry purposes? Was it anxiety, fear?"
The U.S. National Cancer Institute has more on preventive mastectomy.
Posted: September 2009