Rising Rate of Double Mastectomies
Well, back at work this morning with the saving grace of good internet service. Thank you for putting up with my complaints and shorter entries from Maine last week.
Today's topic is one that I have surely written about in the past, but the news keeps rolling in. Increasingly, women are opting for bilateral (double) mastectomies when there is no medical advantage in doing so. There are times when that is the recommendation: women who carry a BRCA gene mutation or have a very strong family history or a particular breast cancer presentation that is worrisome to her doctors. Most of the time, however, there is absolutely no medical reason or survival advantage to this choice.
It is especially worrisome to me that many women are making this decision after hearing the opinions of friends or family. Even when those opinions differ from those of her doctors, she is heeding them. We all know how terrifying the early days are, and I completely understand the wish to do anything and everything to stay well--but losing both breasts usually won't help with that goal.
When I meet with women who are in the throes of this decision process, I try to help them slow down, understand the realities, carefully consider their options. There is sometimes a possible compromise decision: have lesser surgery now and, if you find you can't sleep at night a year later, come back for more. Insurance companies, as long as there is solid medical documentation (and there easily can be), will pay for that. In my experience, no one has ever come back later for more.
This is a very good summary from the Wall Street Journal. I give you the start and then a link to read more:
The Double Mastectomy Rebellion
BY LUCETTE LAGNADO
Defying Doctors, More Women With Breast Cancer Choose Double
After she was diagnosed with cancer in her left breast last fall, Chiara D’Agostino turned to two holistic healers, a psychotherapist, a massage therapist, a hospital social worker, a meditation class and two support groups to help her navigate a frightening new world.
One piece of advice she doesn’t plan to follow: her doctor’s. The surgeon recommended a single mastectomy along with chemotherapy and radiation. But many women in the support groups argued that she should get both breasts removed.
One warned Ms. D’Agostino that her healthy breast would eventually sag while the reconstructed one stayed perky. Others, trying to be helpful, would lift their tops to show off their new figures. “I was like, ‘You are crazy. I would rather keep my breasts,’ ” said Ms. D’Agostino, a 43-year-old former Italian teacher from New Jersey. But after hearing the message for months—and discovering that her insurance would pay for the second procedure—she decided to have her healthy breast taken off and reconstructed too.