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A Very Fine Piece re Mastectomies

Posted 8/3/2014

Posted in

  In all candor, I do appreciate that some of you may be sick and tired of the continuing entries re "elective" bilateral mastectomies and women's choices. For me, this question comes up at least two or three times each week in my office. I sit with women who are overwhelmed, scared, and trying hard to make the best possible choice for themselves. For almost everyone who is newly diagnosed, the central fear is survival. The question about surgery, as related to that worry, is which choice (if any) will improve the odds of staying well.

  As you have heard me say (or read here) over and over, and as you may know anyway, for most women, survival is not improved by mastectomy vs wide excision/lumpectomy and radiation. For most women, survival is not improved by opting for two mastectomies. There are exceptions: women who carry a BRCA gene, women with very strong family histories, women in unusual medical situation that motivate their surgeons to make this suggestion. And even for these women, the choice is rarely about survival and more about reducing the chances of an eventual second breast cancer in the other breast. One fact: breast cancer does not move from one breast to the other. If breast cancer is later diagnosed in the second breast, it is a new one.

  This is a superb piece from Breast Cancer Action in San Francisco. I strongly urge you to read it. Here is the start and a link:

On Mastectomies, Pink Ribbon Culture, and Women’s Choices 

By Karuna Jaggar, Executive Director

The decision to surgically remove a breast either to treat or prevent cancer can never be taken
lightly. And, in our breast-obsessed culture, for many women this medical decision is further
complicated by societal pressures and norms.
Thankfully, the days of Halsted’s radical mastectomy are behind us. No longer do women go into
surgery to find out if they have breast cancer and wake up to their entire breast removed, including
muscle and in extreme cases ribs. Women now have the choice of mastectomy (including a nipplesparing
technique) or lumpectomy with radiation. How and why women make these decisions is
complicated and always personal.
As the watchdog of the breast cancer movement, part of our work is to ensure that women have access to unbiased, evidence-based information in order to make their own healthcare decisions. As a feminist organization, we always value and respect women’s diverse experiences and choices, even when those choices may be controversial or unpopular. Some women choose the standard of care, while others may opt for either more or less than the current standard of treatment.


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