In 2012, one in three women with breast cancer who are under 45 years old opted to have her healthy breast removed along with the affected breast. The rate marks a significant increase from a rate of just one in 10 younger breast cancer patients who had double mastectomies eight years earlier.
Double Mastectomy Does Not Offer Survival Benefit
Experts said that the decision to undergo additional surgery is an extremely personal decision. However, researchers of the new study that examined the proportion of women diagnosed with cancer in one breast who undergo double mastectomy said that evidence does not support the need to have the healthy breast removed in average-risk women.
"The use of contralateral prophylactic mastectomies (CPMs) among patients with invasive unilateral breast cancer has increased substantially during the past decade in the United States despite the lack of evidence for survival benefit," said Ahmedin Jemal of the American Cancer Society in Atlanta.
Preventive Mastectomy For Women With Genetic Risk Factors
The American Society of Breast Surgeons and the American Board of Internal Medicine also do not recommend the practice known as contralateral prophylactic mastectomy, except in women who have an unusually high risk of developing a new cancer because of genetic factors - such as having the mutation in the BRCA1 or BRCA2 genes.
The "Angelina Jolie effect" is being attributed to as a potential factor for the rising rates in double mastectomy, but the actress, who decided to have both her breast removed, has BRCA gene mutation, which increases her risk of breast cancer.
E. Shelley Hwang from the Duke Cancer Institute has studied the quality of life of patients who underwent double mastectomies. She said that the new research, which was published in JAMA on March 29, underscores the fact that women make the decision out of anxiety and not because of medical necessity.
Opens Door To Risks And Complications
Mehra Golshan from the Brigham and Women's Hospital, who co-authored a 2015 study that found an increase in patients with stage 1 to stage 3 cancer in one breast who decided to have CPM, expressed her concern over the trend.
"I wasn't surprised, because I see it every day in my practice - but it is somewhat concerning," Golshan said. "Double mastectomy isn't without risks, especially when you have reconstruction, too - which the majority of women choose to do. And it doesn't increase your chance of surviving the cancer, because breast cancer is unlikely to spread to the other breast."
Lisa Newman, from the Henry Ford Health System in Detroit, advised women to discuss the procedure with their surgeons first. She noted that while removing the healthy breast may provide reconstruction advantages, this does not offer survival advantage and may even open a door to complications.
"These surgical options do not provide any survival advantage," Newman said. "We as physicians must ensure that [patients] understand that the more extensive surgery has a higher complication rate; that it is risk-reducing but not risk-eliminating; and that it does not improve likelihood of curative treatment for the initially diagnosed breast cancer."
