Breast Cancer and the Dilemma of Double Mastectomy

Breast Cancer
Breast cancer is often seen as a controversial topic within medicine due to the high number of diagnoses made each year. The UK and U.S. alone have some of the highest incidence rates worldwide, which is why so many women face tough decisions when it comes to long-term health. For many, breast cancer remains a private battle as they confront the dilemma of whether or not to have a double mastectomy. A new study shows patients can cut their risk of dying in half, if they opt to remove both breasts.

The study by BMJ revealed that patients with the specific mutations in genes BRCA1 or BRCA2 will benefit most. Not everyone is an ideal candidate. Only women with these mutations, who were diagnosed with early-stage breast tumors, were involved in the group study. It is estimated that up to 10 percent of women diagnosed are carriers of this genetic mutation. Being a carrier significantly increases a woman’s lifetime risk of developing breast cancer. These are daunting statistics for anyone exploring treatment options.

Experts say the risk rises to 70 percent when BRCA mutations are present.

To complicate matters, several studies have shown that early menopause can actually lower the risk of radiation related breast cancer. More research is needed to see how genetics and radiation therapy are connected. The study by BMJ represents a significant and positive step forward in understanding the connection, specifically how mutations impact a woman’s long-term treatment.

Crucially, the study did not include the benefits of double mastectomies on healthy patients who had a family history of cancer. In 2013, Angelina Jolie made headlines for having both her breasts removed. The actress chose to undergo the procedure after a test revealed she had one of the genetic mutations. It is well documented that the actress’s mother and aunt both died of cancer.

While women with mutations are at risk of developing breast cancers at a young age, many patients struggle with the dilemma of double mastectomy and the prospect of breastfeeding their child. Angelina Jolie had already given birth to three children before her controversial decision to remove both her breasts in a preventative operation. Women who are not in this position, who may have been recently diagnosed with early-stage tumors, face stark choices. Their dream of becoming a mother and breastfeeding their children may be offset with long-term health concerns. These women may also carry traumatic experiences of a relative’s or friend’s battle.

Both grief and stress play a vital role in the decision whether or not to remove both breasts. Most experts agree that the benefits of double mastectomy only come 10 to 20 years after surgery. Doctors are still debating whether long-term health risks outweigh the trade-offs women make as mothers. Traditionally, most patients have opted to remove only one breast and attend vigorous health-checks and screenings. However, women who suffer from genetic mutations remain at high lifetime risk of the cancer returning in the other breast and further treatment.

It seems the real dilemma of double mastectomy is faced by BRAC carriers, who have a family history of cancer in the breast or ovaries. These women face an unimaginable decision between safeguarding their health and fully experiencing motherhood; something which many carriers liken to a “gun” against their head. Further investigation is needed to help these women make the most informed decision. The BMJ study is one step in the right direction.

By Simone Innamorati


USA Today

Worldwide Breast Cancer

American Cancer Society

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