Double Mastectomies To Prevent Breast Cancer Increase

From 1998 through 2003, the rate of double mastectomies among women in the United States who had cancer diagnosed in only one breast more than doubled, according to a report in the Journal of Clinical Oncology.

"Many surgeons had noticed that more women were requesting double mastectomy for treatment of the cancer in only one breast. So, we weren't surprised by the overall trend, but we were very surprised by the magnitude," lead author Dr. Todd M. Tuttle said in an interview with Reuters Health.

What is driving this trend will require further studies, added Tuttle, from the University of Minnesota in Minneapolis. In the meantime, he advised, it is critical that physicians be aware and inform their patients that "although there may be sound reasons for undergoing double mastectomy (avoidance of future mammograms and preventing a new cancer), the procedure does not improve breast cancer survival."

The new study involved an analysis of data for 152,755 women who were diagnosed with cancer in one breast between 1998 and 2003 and entered in the Surveillance, Epidemiology, and End Results (SEER), the US National Cancer Institutes' database.
Overall, 4,969 patients elected to undergo preventative mastectomy in the other breast. The rates of the operation were 3.3 percent among women who had any surgery, including those who underwent single mastectomy or only had their tumor removed, and 7.7 percent among mastectomy patients.

The overall rate of double mastectomy - that included removal of an unaffected breast climbed from 1.8 percent in 1998 to 4.5 percent in 2003, the report indicates. Among mastectomy patients, the rate rose from 4.2 percent to 11.0 percent. These trends were noted for patients at any cancer stage and were still apparent at the end of the study period.

Characteristics of the women who underwent double mastectomy included younger patient age, non-Hispanic white race, lobular breast cancer type, and a prior cancer diagnosis, the researchers found. Large tumor size was associated with an increase in the overall rate of the procedure, but with a decrease in the rate among mastectomy patients.

"The main unanswered question from this research is: why are more women choosing to undergo double mastectomy?" Tuttle said. "For our next research project, we will interview breast cancer patients before and after surgery to determine what factors influenced their surgical decisions. We will also interview patients' surgeons to determine their advice."

AUTHOR: Anthony J. Brown, MD
SOURCE: Journal of Clinical Oncology, October 22, 2007 online.

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High Risk of Breast Cancer: 4 Factors

Breast cancer has struck within my family, and when it did I was worried not only for my relative (she's fine now, thank goodness), but also for myself.

After her diagnosis, when I asked my doctor if I should do anything beyond the norm to safeguard my health, the doctor's answer was, "Many more women who have no known relatives with breast cancer get the disease than do those who have a family history."

This was her way of reassuring me, and I've continued to live healthy by getting the usual screenings and not worrying constantly that I will be diagnosed. Every year I schedule my mammogram, and every so often I do a self exam, and I tell other women to do the same. These are the best cancer-fighting aids we have: awareness, action, and advocacy.

To get a quick snapshot of your own risk, based on your family history, Therese M. Bevers, M.D., medical director of the Cancer Prevention Center at The University of Texas M. D. Anderson Cancer Center, suggests you ask yourself the four following questions:

1. Do you have at least two blood relatives who were diagnosed with breast cancer before menopause?

2. Do you have a blood relative who was diagnosed with breast cancer before menopause and a blood relative who developed ovarian cancer at any age?

3. If you have a family history of breast cancer, were any of the diagnosed relatives male?

4. Is your family of Ashkenazi Jewish descent?

If you answered yes to 1, 2 or 3, or to 4 along with any other question, your family history of breast cancer implies a genetic predisposition, says Dr. Bevers.

Talk with your doctor about whether you should consider seeing a genetic counselor, who can give you a much more complete assessment of your risk. (You can also find a genetic counselor yourself at the National Society of Genetic Counselors.

If you learn that you are indeed at high risk, organizations like FORCE, Facing Our Risk of Cancer Empowered, can provide additional information and support.

One more very important point: The American Cancer Society now recommends that certain women who have a higher-than-average risk of breast cancer get a breast MRI along with their mammogram; and depending on the details of your family history, you may need to start screening as early as age 30 or sooner.

The test is able to spot changes that the X-ray might miss (though be warned that means a higher chance of an unnecessary biopsy). Who exactly should consider it? Women who have tested positive for a BRCA mutation; those who have a first-degree relative with a BRCA mutation; women who had radiation to the chest between the ages of 10 and 30 and those whose lifetime risk is 20 percent or higher.

If you said no to all of the questions listed above, or yes only to number 4, you are likely at average ris, which is probably lower than you think. A woman who has no family history has just a one in 13 chance of developing breast cancer in her lifetime, according to large study published in The Lancet.

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Author Bio: Lucy Danziger is the editor-in-chief of SELF magazine. In 1991, SELF founded the Pink Ribbon to raise awareness and funding for breast cancer research. Each October, SELF produces a Breast Cancer Handbook feature. The 2005 handbook won a National Magazine Award for Personal Service. Danziger lives in Manhattan with her husband and two children.

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