More women who have cancer in only one breast are getting both breasts removed, despite a lack of evidence showing that double mastectomies increase survival in most women, researchers reported Monday.
It's still a rare option - most breast cancer is treated by lumpectomy, removing just the tumor while saving the breast. But almost 5 percent of patients decided to have the radical procedure in 2003, up from just under 2 percent in 1998 - with no sign that the trend is slowing.
If the figures are accurate, 8,000 to 10,000 patients a year may be electing to have the procedure.
The reasons the women, particularly young white women, are pushing for the more aggressive procedure are not totally clear.
The researchers surmised that some women believe the health care system did not detect their tumor early enough and that continued screening would not be effective, while others might have been traumatized by chemotherapy. Improvements in reconstructive surgery also have made a double mastectomy a more acceptable alternative.
Dr. Todd Tuttle, cancer surgery chief at the University of Minnesota, led the study after noticing that more women sought the option in his own hospital.
"If they are making this decision based on fear, and thinking that it will increase their survival, then that would concern me," said Dr. Julie Gralow of the University of Washington, a spokeswoman for the American Society of Clinical Oncology. "But if they understand that it won't necessarily improve their survival, and that emotionally it is the best thing for them, then we would have to support it."
Dr. Benjamin Paz of the City of Hope Comprehensive Cancer Center in Southern California finds the trend "alarming, because the goal of medicine is to help people live well with their organs."
Paz, who was not involved in the study, attributes the trend in large part to the increasing use of MRI imaging, which reveals many small lesions in breasts that weren't observed before. "A woman goes through this, and she feels that (the cancer) is spreading all over. It is very difficult to explain to such a woman that she can be treated with breast conservation."
Dr. Christy Russell of the University of Southern California's Keck School of Medicine, who also was not involved in the study, said, "Some women are so traumatized by having a breast cancer, especially if it is not found early, that they have a lack of trust in the whole system of finding the next one early. It seems easier to remove everything and not have to deal with mammography screening any more."
Don't underestimate the peace of mind that brings, said Trisha Stotler Meyer of Vienna, Va., who had her breasts removed three weeks ago.
"Doctors are not up at night crying" in fear of their next mammogram, said Meyer, 37, who went back for a double mastectomy after her initial cancer surgery. "I don't want to have to deal with the stress."
Some women at high risk, because of notorious breast cancer genes or family history, choose preventive mastectomies before cancer ever strikes.
Paz and Russell said they spend a great deal of time counseling patients about the potential problems and benefits of double mastectomies.
"The breast is a sexual organ, and they need to understand the implications of having both removed, in terms not only of physical appearance but also of their sex life and sexuality," Russell said.
"And what is not being said in this paper is the cost of all this," Paz added. Mastectomy and reconstruction of the second breast costs from $10,000 to $30,000 per woman, he estimated. "The cost to society is very significant."
Information from the Los Angeles Times and Associated Press was used in this report.
By the numbers
- Overall, the rate of double mastectomies rose from 1.8 percent in 1998 to 4.5 percent in 2003, the latest period for which data is available. Among women having a mastectomy, the proportion having the second breast removed as a prophylactic rose from 4.2 percent in 1998 to 11 percent in 2003.
- An estimated 178,480 women will be diagnosed with breast cancer this year, and about 40,460 will die of it, according to the American Cancer Society.