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 Based on a decade of data on half a million women diagnosed with
cancer in one breast that had not spread to other parts of the body,
researchers found that removal of the second, healthy breast rose
from 4 percent of patients in 2002 to nearly 13 percent in 2012.
But for women who chose so-called contralateral prophylactic
mastectomy, the odds of death from breast cancer or from any cause
were no different than those of women who just removed the tumor or
the affected breast.
“It seems that what we’re often doing is overtreating breast
cancer,” said senior author Dr. Mehra Golshan by email.
“Most women with early stage breast cancer will not benefit from
having both breasts removed,” said Golshan, the chair of surgical
oncology at Brigham and Women's Hospital in Boston.
For the study, published in the Annals of Surgery, Golshan and
colleagues analyzed a nationwide cancer database, focusing on
496,488 women diagnosed with stage I, II and III cancers in only one
breast between 1998 and 2012.
They also looked at survival rates among more than 200,000 women
through 2007.
Overall, around 60 percent of women underwent breast-conserving
surgery, meaning removal of only the tumor, 33 percent removed only
the diseased breast and 7 percent removed both breasts.
Nearly half of the women who had both breasts removed had
reconstructive surgery, compared to 16 percent of women who removed
one breast.
Golshan noted that while techniques are improving, surgery to remove
breasts is still very serious. Operations can take between three and
12 hours, recovery can last a couple of months and women often lose
most of the feeling in their chests.
He said that women may fear going through the experience of finding
another lump in their other breast and not being able to work or
sleep while waiting for test results.
Past research has found that anxiety and a lack of information about
the risks and benefits can drive women to opt for preventive removal
of a healthy breast (see Reuters Health story of April 22, 2015,
here: http://reut.rs/22oMubV).
Dr. Monica Morrow, chief of the breast service at Memorial Sloan
Kettering Cancer Center in New York, who was not involved in the
study, also said that “having peace of mind” may motivate many women
to choose to remove both breasts.
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“Removal of the normal breast does nothing to reduce the risk of
dying of the cancer that is already present, it simply reduces the
risk of making a second cancer in the other breast (although it
doesn’t make the risk zero),” Morrow said.
This risk of developing cancer in the opposite breast is very low
for the vast majority of women, at around 0.5 percent chance,
Golshan said.
He and his coauthors note in their report that even after adjusting
for the subtype of cancer women had and other risk factors, there
was no statistically significant difference in survival rates
between women who had breast-conserving surgery and those who
removed both breasts. But there was “slightly worse survival” among
women who removed both breasts. There was not enough data to explain
that pattern, however.
What has come to be known as the Angelina Jolie effect may be
another factor in the trend toward removing both breasts,
researchers noted. Publicity about celebrities who had genetic
predispositions to cancer and preventively removed both breasts may
have contributed to people believing that removal of both breasts is
a “safer” approach, Morrow said.
“Women should talk to their doctors to find out what their actual
risk of development of a second cancer is estimated to be before
making this decision,” she said.
“Surgeons should be operating less and we should have that
discussion with the patient about the pros and cons of all the
approaches,” Golshan said.
SOURCE: bit.ly/1Lt0WYV Annals of Surgery, online March 8, 2016.
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