November 29, 2012 | by Roberta Nichols
Double mastectomies are becoming more common across the country, as women with cancer in one breast increasingly choose to have both that breast and the healthy breast removed. A new study suggests the removal of both breasts is often far from necessary, a finding that raises complex questions for breast cancer experts.
Of 1,500 women treated for early stage breast cancer, 20% of those who chose mastectomy over lumpectomy opted to have both breasts removed, not just one, the study found. But three-quarters of those had no medical reason for doing so.
Many of the women had been diagnosed with ductal carcinoma in situ, sometimes called a stage zero breast cancer, as an NPR story on the study points out. Such cancer is limited to the milk ducts only, not surrounding tissue.
Breast surgeon Monica Morrow of Memorial Sloan-Kettering Cancer Center, a co-author of the paper, told NPR that many participants mistakenly believed that the cancer would “spread” to the unaffected breast.
Such fears are familiar to Laura Kruper, M.D., director of the Cooper Finkel Women’s Health Center and co-director of the Breast Cancer Program at City of Hope. Although she wasn’t involved with the current study, Kruper has researched the reasons women choose what’s known as a contralateral prophylactic mastectomy -- a mastectomy of the breast unaffected by breast cancer.
“The main reason listed by women who underwent CPM was ‘fear of recurrence,’” she says.
Although patients’ perceived risk is much higher than reality suggests, she has found, many are comfortable with their decision to undergo removal of a healthy breast.
“For the majority of women with breast cancer in one breast, there is no overall improvement in overall survival from having the unaffected breast removed, but the satisfaction rates for these women are extremely high,” Kruper says.
“In our study conducted at City of Hope [presented at ASCO's annual meeting in June], we demonstrated that women who underwent a mastectomy on one side with CPM, had consistently higher satisfaction rates than women who underwent a unilateral mastectomy.”
Morrow says the patient demand for mastectomies is ironic. “It took years of pressure from the then-nascent patients' rights movement, along with the evidence from controversial research studies, to establish breast-conserving lumpectomy as a valid alternative to mastectomy,” she says.
Adds Kruper: “As a surgeon, yes, it is at times difficult to see women with very small cancers opting to undergo bilateral mastectomies. how do we as surgeons address this issue?”
“When patients are motivated by "fear of recurrence", what then defines "medically necessary"? she says.