Double Mastectomies: What Price Peace of Mind?

More and more women are choosing to have the surgery in hopes of lowering their risk of breast cancer. What have they gained? And what have they lost?

by Ginny Graves
Photograph: Chad Hagen

If you've been diagnosed with breast cancer in one breast
A decade ago, lumpectomy with radiation was the usual treatment. Now an increasing number of women who are diagnosed with cancer in one breast are choosing to have both removed—the healthy one along with the cancerous one. In the largest study to date, published in 2007, researchers at the University of Minnesota looked at more than 150,000 women with cancer in one breast and found that over the six years of the study, the rate of double mastectomy nearly tripled, from 4 percent to 11 percent. In 2010, researchers at the MD Anderson Cancer Center confirmed the trend: In the span of seven years, the percentage of women with cancer who opted to have a double mastectomy shot from 7 percent to 14 percent, and most of those who underwent the procedure didn’t have a known genetic pre-disposition to the disease.

Among women with DCIS, a noninvasive condition in which abnormal cells are confined to the milk ducts, double mastectomy has increased to almost 20 percent—a rate that is too high, says Todd Tuttle, MD, chief of surgical oncology at the University of Minnesota Medical School. “The 10-year risk of getting DCIS or invasive cancer in the healthy breast is low—about 5 percent,” Tuttle says.

[Related: “I Could Not Live with the Worry That My Stage-0 Cancer Would Recur.”

Why are so many women opting for preventive surgery? “Women who’ve been diagnosed with breast cancer are worried about having to go through the experience again down the road, and double mastectomy seems like the safest way to prevent a repeat bout,” Litton says. But this drastic surgery may not be the most appropriate path, given its low benefits. For one thing, the chance of getting cancer in the unaffected breast is far lower than most patients believe. In a University of Minnesota survey, women who had cancer in one breast put their odds of getting cancer in the unaffected breast at over 30 percent. The actual risk? Four to 5 percent, says Tuttle, the study’s lead author. Another recent survey of breast-cancer survivors who opted for double mastectomy found that 94 percent made the choice partly to improve their chances of survival. “The trouble is, having a healthy breast removed doesn’t improve your survival rate one bit,” says Tuttle, who has done research on these outcomes.

 “Breast cancer doesn’t usually develop in the other breast,” he explains. “It spreads to the lungs or liver or bones or brain. Having a double mastectomy doesn’t affect those more likely problems at all. Most women could be as effectively treated with lumpectomy and radiation.” That approach might leave some women with lingering anxiety, acknowledges Dianne Shumay, PhD, associate director of psycho-oncology at the Helen Diller Family Comprehensive Cancer Center in San Francisco. “Fear and worry don’t respond to logical argument—and our research has shown that there’s not a linear relationship between level of risk and amount of anxiety,” she says.

[Related: "I was battling an aggressive cancer."]

The aftermath of surgery
What are the pros and cons of surgery? “On the plus side, mastectomy and reconstruction techniques have improved—and it’s easier to create symmetrical breasts if you do both sides at the same time,” says Attai. “Many of my patients voice concern about the symmetry issue.”

The minuses: The surgery is major—most women can’t return to work for six to eight weeks. Reconstruction, if performed, brings a host of potential complications, including infection, leaky implants and capsular contracture, a condition in which the tissue around the implant becomes hard and painful. “I tell patients they have a 40 to 50 percent chance of needing a -follow-up operation,” says Attai.

First published in the February 2014 issue

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