Younger women diagnosed with breast cancer sometimes opt to have their healthy breast removed along with the one containing the malignancy. In five states, nearly half of all women under 45 have both removed, far higher than the national rates. In fact, the odds of having a double mastectomy (also known as a contralateral prophylactic mastectomy or CPM) varies based on where someone lives, according to a new study in JAMA Surgery.
The prevalence of double mastectomies has increased nationally for women under 45 as well as for those over. Those under 45 typically opt for aggressive treatment versus women diagnosed later in life.
Many women view the bilateral mastectomy as a risk-reducing decision. Some health officials called this the Angelina Jolie effect (the actress had both breasts removed after finding she carries the BRCA-1 gene mutation that causes breast cancer). Some women fear that the finding of cancer in one breast increases the likelihood of cancer in the unaffected one, even though the probability for most is not high. One reason they did not expect to find was a geographical one.
Researchers studied mastectomy rates between 2010 and 2012 throughout the U.S. They found a huge difference in five contiguous Midwestern states. About 49 percent of women in South Dakota aged 20 to 44 who were diagnosed with cancer in one breast had both breasts removed. Rates were also noticeably high in Colorado, Iowa, Missouri, and Nebraska.
By contrast, only 15 to 16 percent of younger women opted for double mastectomies when only one breast had cancer signs in Hawaii and the District of Columbia. Less than 25 percent of such women did in Alaska, Delaware, Idaho, Louisiana, Massachusetts, Nevada, New Hampshire, New Jersey, South Carolina, and Wyoming.
What about for older women? The researchers found that the rates of CPMs for women at least age 45 rose from 3.6 percent in 2004 to 10.4 percent in 2012. By contrast, for women ages 20 to 44, the rate during the same period went from 10.5 percent to 33.3 percent nationally. (Combined the rate is 13.5 percent in the U.S. which is dramatically higher than other countries, like the United Kingdom which has a 2 to 3 percent overall rate for optional double mastectomies.)
The so-called Angelina Jolie effect does not explain the overall increase in U.S. numbers. The actress had her surgery in 2013 – after the period the researchers studied.
Researchers did not offer a hypothesis for the rate variation between states. Additional research is needed on the geographic differential and potential influence from others in the community.
In the meantime, healthcare professionals are urging doctors to educate patients about the questionable benefit and cost of a CPM. In 2016, the American Society of Breast Surgeons issued a recommendation against removing both breasts in women with unilateral breast cancer. The American Board of Internal Medicine has also made a similar recommendation. Their guidance statements are national, so maybe the odds of having double mastectomy will not be so varied by state in the future.
By Dyanne Weiss
Reuters: U.S. rates of double-mastectomies for breast cancer vary by state
JAMA Surgery: State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012
JAMA Surgery: Do Patterns of Breast Cancer Surgical Care Reflect National Voting Records?
Photo courtesy of United States Marine Corps (public domain)