Bilateral Mastectomy Rates HaveTripled In the Past 10 Years

A woman being wheeled into surgery.
A woman being wheeled into surgery. Janie Airey/Getty Images

There is growing concern in the breast cancer oncology community regarding the marked increase in women choosing to have a bilateral mastectomy, which is the removal of both breasts, when only one breast has been found to have a cancer. Despite evidence showing that having a healthy breast removed does not insure better survival outcomes following a first breast cancer in one breast, the rate of women choosing a bilateral mastectomy has tripled in the past 10 years.

In a study conducted at Brigham and Women's Hospital,in Boston, Massachusetts, which appeared in the Annals of Surgery, researchers reported on the findings of analyzing data from almost 500,000 women diagnosed with a stage 1, or 2, or 3 cancer in one breast. Researchers followed the women over eight years. About 60 % of the women had breast-conserving surgery. Another 1/3 of the women had the cancerous breast removed, and 7 % had their other breast, the healthy breast, removed.

Researchers found that women who chose to have their healthy breast removed didn’t have significantly higher rates of survival than those women who had chosen breast-conserving surgery. Caucasian women were most likely to have a healthy breast removed at the same time as having surgery on the breast with a cancer.

The study noted, however, that more aggressive treatment may improve survival odds for those patients at high risk of breast cancer, such as BRCA gene mutations, or a strong family history of breast or ovarian cancer.

Yet, only a third of the women in the study that had their healthy breast removed were at high risk.

The researchers pointed out that it is important for a surgeon to understand why a woman, who is at low risk, wants a more aggressive treatment than a mastectomy to remove the affected breast, or a lumpectomy followed by radiation.

While it is ultimately a woman’s choice as to her surgery, a surgeon can speak to her concerns during their first appointment and weigh the pros and cons of more aggressive surgery.

So why are women choosing to remove a healthy breast as well as the breast that has a cancer? Why are they having more extensive surgery, risking infection, and possibly having additional side effects?

The study’s senior author Dr. Mehra Golshan, who is the chair of surgical oncology at Brigham and Women's Hospital in Boston, shares his impressions of why women are choosing mastectomies over breast conserving surgeries and bilateral mastectomies over mastectomies. He states, “Women continue to report a desire to extend life as one of the most important factors leading to their surgical decision."

Dr. Golshan goes on to say, "Patients and caregivers should weigh the expected benefits with the potential risks of removing the healthy breast including prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and the effects on self-image."

While most breast cancers occur only in one breast; there can be many reasons a woman chooses to have her healthy breast removed in addition to the ones identified in the study done at Brigham and Women's Hospital including but not limited to:

  • Physician advice
  • Strong fear of recurrence in the breast having a cancer
  • Fear of a second primary breast cancer in the healthy breast in the future
  • Cosmetic reasons, such as breasts that have symmetry.

Seven years ago, I had a bilateral mastectomy after being diagnosed with a second primary breast cancer in my left breast. Ten years earlier, my first breast cancer occurred in my right breast. It was treated with a lumpectomy and radiation. I chose a bilateral mastectomy to reduce, as much as possible, the chances of a local recurrence in either of my breasts.

The women I met while serving as a hospital navigator for the American Cancer Society shared other reasons for choosing to have a bilateral mastectomy, such as:

  • Reducing the odds of every having to go through breast cancer treatments again
  • Improved techniques in breast reconstructive surgery
  • Insurance coverage for breast reconstruction
  • The opportunity to have reconstructive surgery that gives a normalizing appearance

The study indicates that reconstruction rates increased in women who had a mastectomy as well as those having a bilateral mastectomy between the years 2002 and 2012.

SOURCE: Brigham and Women's Hospital, news release, March 11, 2016

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