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Why Women Choose Bilateral Mastectomies

Posted 7/17/2014

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  If you are a regular reader of this blog, you know that this is a recurring topic. Increasing numbers of women are opting for bilateral mastectomies when that choice is not medically necessary. This is a worry for surgeons (who never like to remove a healthy organ) and for others who think about the trend.

  Of course there are women and situations in which this surgery is absolutely the right thing to do. Obvious examples include women who carry the BRCA1 or BRCA2 gene or who have a strong family history, women who have had multiple breast cancers, women with other medical issues that make this a wise choice. In my experience, as I talk with women who are struggling to decide what to do, the overpowering factors too often have more to do with fear. By and large, this fear, although totally understandable, is not based on fact, and a little time and space might help some women consider it more thoroughly.

  Let me say again that I will always support a woman's choice and strongly believe that we each make the right choice for ourselves. I do hope, however, that women thinking about surgery have all the information and facts that they need and have a chance to explore their feelings and fears and to be clear about the reasons for their choice.

  This is an excellent article from Nature Reviews about this. I give you a few quotes and a link:

Why do women opt for contralateral
prophylactic mastectomy?
Aron Goldhirsch and Shari Gelber

The decision of patients with breast cancer to have contralateral
mastectomies is often related to their genetic risk. However, the
increasing frequency of this surgical approach is also associated with
social and psychological issues such as celebrity experiences and fear
of contralateral breast cancer. Appropriate counseling may better inform
patients’ surgical choices.

We live in a fascinating period in which information (and misinformation) is
available with increasing ease, rendering
it difficult for people to sort out the data
that will be truly useful. Whereas reliable
reports suggest that breast cancer risk can
be reduced by bilateral breast removal5 and
by prophylactic oophorectomy (in young
women)6 in women with demonstrated
genetic risk for the disease, the chance of
reducing risk of breast cancer by surgical
means in other circumstances—such as
dense breasts or previous radiation to the
breast region while treating a malignant
lymphoma—has not been proven.

Although CPM might be a reasonable
option for women with demonstrated
high genetic risk, all women would benefit
from assistance in decision making during
treatment planning. When pathological
characteristics of the tumour and extent
of the disease are explained to patients,
discussions regarding genetic risk may
aid patients and care givers in deciding
whether CPM might be a suitable option.
Patients considering CPM motivated primarily
by fear might also benefit from
appropriate counseling.

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