May 22, 2014
Breast Cancer Diagnosis Often Leads Women To Have An Unnecessary Double Mastectomy
Brett Smith for redOrbit.com - Your Universe Online
One year ago last week, Angelina Jolie announced in a New York Times op-ed that she had undergone a preventative double mastectomy – but now a new study indicates that surgically removing both breasts may be unnecessary for women who are diagnosed with cancer in a single breast.
Published in the journal JAMA Surgery, the new study found that approximately 70 percent of women that have both breasts removed after having a breast cancer diagnosis in a single breast do it regardless of having a low risk of having cancer in the healthy breast.
The results of the study are particularly concerning given report of female breast cancer patients increasingly choosing to undergo the preventative measure – called contralateral prophylactic mastectomy (CPM).
"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," said study author Sarah Hawley, an associate professor of internal medicine at the University of Michigan’s Medical School.
In the study, researchers examined more than 1,400 women who had been treated for breast cancer and who had not had a recurrence. They discovered that 8 percent of women had both breasts removed and 18 percent thought about it.
Overall, around three-quarters of patients said they were very concerned about their cancer recurring. Those who decided to have both breasts removed were considerably more prone to say they were worried about recurrence. However, a prognosis of cancer in one breast does not boost the odds of breast cancer affecting the other breast for most women.
The study also looked into approximate clinical signs for double mastectomy, such as the patients' family background of breast and ovarian cancer and the outcomes of any genetic evaluating.
Women with a family background of breast or ovarian cancer or who tested positive for mutations in the BRCA1 or BRCA2 genes may be asked to think about having both breasts removed, because they are at an elevated risk of a new cancer establishing in the other breast. This signifies approximately 10 percent of all women identified as having breast cancer. Women devoid of these signs will probably not develop another cancer in the healthy breast.
The study discovered that among women undergoing double mastectomy, almost 70 percent did not have either a family history or positive genetic test. Angelina Jolie did report testing positive for a mutation in the BRCA1 gene.
"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," Hawley said.
"Decision making surrounding early breast cancer, with respect to CPM in particular, provides an opportunity to encourage a supportive, shared decision-making approach,” wrote Shoshana M. Rosenberg and Dr. Ann H. Partridge of the Dana-Farber Cancer Institute, Boston in an editorial accompanying the study.
“Not only should pros and cons of different treatment options be communicated, but there needs to be consideration of the patient's personal circumstances and perceptions, all the while addressing anxiety and concerns about breast cancer recurrence and new primary disease (and the distinction between the two),” the editorial continued. “Finding balance around this issue, like the decision process itself, should be a goal shared by patients and clinicians alike."