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 Researchers analyzed survey data from women with early-stage cancer
in one breast and found 17 percent had both breasts surgically
removed as part of treatment.
“For most women with breast cancer, who do not have an inherited
genetic mutation that predisposes them to a high risk of cancer
formation, the risk of developing a second breast cancer in the
other breast is actually quite low,” said lead study author Dr.
Reshma Jagsi of the University of Michigan in Ann Arbor.
“Removing the other breast is an extremely aggressive approach with
little benefit for most women with breast cancer,” Jagsi added by
email. “Yet most women tell us that they pursue this option for
peace of mind; to me, this suggests that at least some women have
not been fully informed.”
Most women with breast cancer have some type of surgery – either a
lumpectomy that removes malignant tissue while sparing the rest of
the breast or a mastectomy that removes the entire breast. After
surgery, many of them also receive chemotherapy to destroy any
remaining abnormal cells and reduce the risk of cancer coming back.
A double mastectomy for cancer in one breast was rare a decade ago,
but has become more common in recent years, Jagsi said.
Most women without an inherited genetic risk for aggressive
malignancy are not likely to develop tumors in a second breast after
cancer is detected in one breast. In fact, they’re more likely to
develop cancer in other parts of their body, rather than in the
second breast, she noted.
For the study, researchers examined data collected in 2013 and 2014
from about 2,400 women with tumors in one breast.
Overall, 1,056 women, or 44 percent, considered a double mastectomy.
Of these, 395 women, or less than half, knew that this course of
treatment doesn’t improve survival odds for all women with breast
cancer, researchers report in JAMA Surgery.
Two-thirds of the study participants didn’t have a high genetic risk
for aggressive tumors, and 39 percent of these women said a surgeon
had advised against a double mastectomy.
In the subset of women without a genetic risk or identified mutation
that boosts the odds for aggressive tumors, 12 percent still had
both breasts surgically removed
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Among these lower-risk women, 19 percent of patients who weren’t
advised against a double mastectomy by doctors underwent the
procedure.
This more aggressive surgical approach to breast cancer carries an
increased risk of pain and complications, particularly if women also
opt for reconstructive plastic surgery.
One limitation of the study is its reliance on women to accurately
recall and report what they discussed with doctors before choosing a
course of treatment, the authors note.
Still, the results highlight a need to balance any psychological
benefit women may be getting from the peace of mind that comes with
removing both breasts against the long term harms of an unnecessary
operation, Dr. Shelley Hwang writes in an accompanying editorial.
In the United States, about one in 10 women with cancer in one
breast decide to have the other breast removed as a preventive
measure, Hwang, a researcher at Duke University Medical Center in
Durham, North Carolina, said by email.
“This is a number that has been increasing significantly over the
last 20 years,” Hwang said.
“This trend has concerned many of us who have worried that women are
making this decision based upon an inaccurate understanding of how
much they may benefit by having this procedure,” Hwang added. “The
current study is important because it surveyed patients about how
they made the decision to have the other breast removed, and
indicates that better education of patients by their surgeons may
help reverse this trend.”
SOURCE: http://bit.ly/2hkUhS2 and http://bit.ly/2hvc0Hq JAMA
Surgery, online December 21, 2016.
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