Fear of cancer recurrence most commonly drives women to choose double mastectomy as a preventative measure when they still have one healthy breast, but according to a new study published Wednesday in the Journal of the American Medical Association (JAMA) the surgery is usually unnecessary. The study, from the University of Michigan Comprehensive Cancer Center, surveyed 1,447 women in California and Michigan to try to determine why some decided on a contralateral prophylactic mastectomy (CPM), or removal of the healthy breast. The women had all been treated for breast cancer and had no recurrence at the time of the study.
According to Dr. Tari King, Memorial Sloan Kettering Cancer Center’s deputy chief and director of research for their breast surgical service, only about 3 percent of breast cancer patients will develop cancer in their healthy breast within 10 years of their first diagnosis. Yet according to a study published in the Plastic Reconstructive Surgery journal, the number of women choosing to have CPM has increased from 39 per 1,000 mastectomies in 1998 to 207 per 1,000 mastectomies in 2008.
Doctors often recommend CPM for patients who have the gene mutations BRCA 1 and BRCA 2, which puts a woman at a substantially higher risk for ovarian and breast cancer. However, only about 10 percent of all women with breast cancer have this condition. The study found that women who are not at high risk typically choose to have CPM out of fear of recurrence.
Sarah Hawley, University of Michigan associate professor and lead author of the study, said that more than two-thirds of CPM surgeries are not actually needed because the women have no family or genetic risk factors. The study also found that mastectomy of the healthy breast does not actually prevent the return of cancer and is generally unnecessary, because most women who choose it are already at very low risk of a breast cancer recurrence.
The celebrity factor has contributed to the recent increase in CPM surgeries. Since Angelina Jolie had the surgery in 2013 she has spoken publicly about her decision to have CPM after learning she had the high cancer risk gene mutation. And Samantha Harris, former Dancing with the Stars host, has been open about her recent double mastectomy, done even though she did not have the high-risk mutation.
As with any major surgery, CPM is not without risk. Complications include loss of sensation in the skin and breast, post-surgical chronic pain, and decreased sexuality. Samantha Harris referred to it as a “grueling” surgery. And many women who have the surgery continue to fear a recurrence of their cancer. King says the choice to remove both breasts does not guarantee that a woman will feel as reassured as they might think they will at the time they make the decision to proceed.
The study found that women with more education were the ones more likely to choose to have CPM, along with the women who had genetic testing, even those whose results came back showing no increased risk. Hawley said this surprised her, as she thought women who had a negative genetic test would be more likely to have their fears put to rest and not opt for surgery. She does not know whether just having the genetic test gets the women thinking about CPM, or if they make the decision to proceed before they get the test results.
The National Cancer Institute and other experts fear that the decision to proceed with the mastectomy of a healthy breast leads to unnecessary surgeries, but the decision is ultimately the breast cancer patient’s personal choice. They say the most important thing a doctor can do to help guide a woman considering a double mastectomy is to provide comprehensive information that includes all possible options, giving the patient the tools to make the right decision for herself.
By Beth A. Balen