November 29, 2012
Researchers Say Double Mastectomies Often Unnecessary
Connie K. Ho for redOrbit.com — Your Universe Online
Researchers from the University of Michigan (U-M) recently discovered that while concern about the recurrence of breast cancer is a major issue for women, most patients who have double mastectomies do not need them.
In particular, the team of investigators stated that, of the women who had both breasts removed, 70 percent had only low risk of developing cancer in their healthy breast. The findings from the Michigan Comprehensive Cancer Center will be presented at the American Society of Clinical Oncology´s Quality Care Symposium on Nov. 30.
"Women appear to be using worry over cancer recurrence to choose contralateral prophylactic mastectomy. This does not make sense, because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast," says Sarah Hawley, an associate professor of internal medicine at U-M Medical School, in a prepared statement.
The results of the study highlight the potential overtreatment with the aggressive surgery known as contralateral prophylactic mastectomy. In the study, 90 percent of women who had both breasts removed stated that they were very anxious about breast cancer developing in their other breast. However, the researchers believe that for most women, breast cancer diagnosis in one breast cannot elevate the possibility of breast cancer occurring in the other breast.
In total, scientists observed 1,446 females who underwent treatment for breast cancer and who did not have a recurrence of the disease. They asked the patients about their family history with breast and ovarian cancer. They also obtained the findings from any genetic tests that the patient had taken. Of the 1,446 participants, about seven percent had undergone double mastectomies.
The researchers described how there are certain factors that may make a physician recommend a double mastectomy. For example, women who have had two or more immediate family members (such as daughters, mothers and sisters) diagnosed with breast or ovarian cancer could be advised to have the operation. On the other hand, individuals who test positive for genetic mutation in genes called BRCA1 or BRCA2 are sometimes advised to have both breasts removed due to the high risk of a new cancer developing. However, the team of investigators believes that these factors do not have a high likelihood of developing into a second cancer.
"For women who do not have a strong family history or a genetic finding, we would argue it's probably not appropriate to get the unaffected breast removed," continued Hawley, who also serves as a research investigator at the Ann Arbor Center of Excellence in Clinical Care Management Research.
Related to other complications and a strenuous recovery, double mastectomies are considered a “bigger operation.” Individuals who also need chemotherapy or radiation therapy following their surgery may slow their overall recovery time by undergoing the invasive procedure. Based on these findings, the researchers believe that it is important to provide education to females about the possibility that double mastectomies may not necessarily decrease the risk of cancer recurrence.
"I believe surgeons are telling their patients that a contralateral mastectomy won't reduce their risk of recurrence and that it is associated with higher morbidity. But this procedure is still done and it's done in women who don't need to have it done. A decision tool like ours will solicit common misconceptions about breast cancer treatment and give women feedback to help them fully understand the options and risks involved," concluded Hawley, a member of the U-M Institute for Healthcare Policy and Innovation, in the statement.