Remember Angelina Jolie underwent double mastectomy as a preventive step for genetic predisposition of breast cancer in 2013. There was a lot of hue and cry over the benefits of double mastectomy and whether it was required. A recent study published in the Journal of the American Medical Association concluded that removing of both breasts to treat cancer affecting only one side doesn’t boost survival chances for most women, compared with surgery that removes just the tumor.
The results raise concerns about riskier, expensive, potentially unnecessary operations that increasing numbers of women are choosing.
Inferences of the Study
The study involved nearly 200,000 California women treated for cancer in one breast and followed for several years afterward.
Ten-year survival rates were nearly identical – roughly 82 percent – for women who had lumpectomies to remove the tumor plus radiation, and for those who had double mastectomies. Women who had a single mastectomy, removal of just the cancerous breast, fared slightly worse.
In the study, just over half the women had lumpectomy treatment. But the number who had double mastectomies increased substantially to 12 percent between 1998 and 2011. The trend was most notable in women younger than 40, climbing from just 4 percent to 33 percent.
Other research suggests that removing both breasts to treat one-sided cancer may improve survival chances for the relatively small number of women who have genetic breast cancer or strong family histories of the disease, said study co-author Scarlett Gomez, a research scientist with the Cancer Prevention Institute of California. But most breast cancer patients have neither of those risks.
Money minting business
The medical community is paying increasing attention to over-treatment and excessive costs, and the study results raise questions about reasons for rising use of an expensive, potentially risky treatment “of dubious effectiveness,” the researchers said.
The results may raise questions about whether surgeons, for financial reasons, are driving the trend, but that is unlikely, Dr. Lisa Newman, a surgery professor and director of the University of Michigan’s Breast Care Center said in the editorial.’
‘A greater concern than financial incentives may be a surgeon’s preference based on his/her own experience, regardless of the data,’ she wrote.
Choosing peace of mind
Most patients undergo double mastectomy to get the peace of mind that the disease will not reappear. Patients’ preferences and fear that cancer will return play a role, but that fear ‘usually exceeds estimated risk,’ the study said.
Reasons why survival was slightly worse for woman who had just one breast removed are uncertain, although this treatment is more common among Hispanic and black women and those with lower incomes and public insurance than among wealthy whites.
Patients should be given time to absorb a cancer diagnosis, and educated about treatment options, risks and benefits, before being pressed into decisions about irreversible surgery, Newman said.
The study authors examined data from the California Cancer Registry, part of a national cancer surveillance program. The data lacked information on how many women had genetic breast cancer or strong family histories of the disease.