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Most Women Do Not Need Bilateral Mastectomies

Posted 5/22/2014

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  I admit that this is a soapbox issue for me. There absolutely are situations in which the choice of bilateral (double) mastectomies is the correct medical decision. This is most often true for women who carry one of the BRCA mutations, but there may be other reasons of strong family history or personal medical history or worrisome findings in both breasts that make this the smart choice. Most of the time, however, women who opt for this surgery do not medically need it.

  The new study from the University of Michigan reports that about 70% (and that feels like a huge number!) of women who have bilateral mastectomies have a very small chance of ever developing breast cancer in the second breast, but make this surgical choice out of fear and the belief that they are doing something to increase the odds of staying healthy. As we know, the real danger for all of us is not what happens in our breasts, but what happens if cells get out and travel and lodge elsewhere in our bodies. It is the possibility of metastatic disease that is the real worry. Cancer in the breast, local disease, can be treated and very often cured.

  As Ann Partridge, MD, a breast oncologist at DFCI is quoted as saying: "Get the breast treated you need to get treated. You can always go back" And, to that point, I have often counseled women with the same advice, reminding them that going back later is an option. In my thirty plus years of doing this work, I have known only one woman who did later return for a second mastectomy. And she did so not out of anxiety, but because she was sick of dealing with a prosthesis and couldn't find a bra that was comfortable, and preferred to opt out of that whole problem.

  From Eureka Alert comes this summary of the JAMA Surgery article. I give you the beginning and then a link to read more:

Most women who have double mastectomy don't need it, U-M study finds
Worry about recurrence was driving factor, but 70 percent had very low risk of
developing cancer in healthy breast
ANN ARBOR, Mich. — About 70 percent of women who have
both breasts removed following a breast cancer diagnosis do
so despite a very low risk of facing cancer in the healthy
breast, new research from the University of Michigan
Comprehensive Cancer Center finds.
Recent studies have shown an increase in women with
breast cancer choosing this more aggressive surgery, called
contralateral prophylactic mastectomy, which raises the
question of potential overtreatment among these patients.
The study authors looked at 1,447 women who had been
treated for breast cancer and who had not had a recurrence.
They found that 8 percent of women had a double
mastectomy, and that 18 percent considered having one.
Results appear in JAMA Surgery.


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