The number of women having both breasts removed after a tumor is found in one increased by 150 percent over a five-year period despite a lack of evidence showing that double mastectomies increase survival in most women, researchers reported Monday.
Current guidelines for treatment of a localized breast cancer call only for removal of the tumor and not for a mastectomy, much less a double mastectomy.
But an increasing number of women, particularly young white women, are pushing for the more aggressive procedure for reasons that are not totally clear, the researchers said.
They 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.
“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,” said Gralow, who was not involved in the study.
Dr. Benjamin Paz of the Southern California-based City of Hope Comprehensive Cancer Center , however, 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.
Dr. Todd Tuttle of the University of Minnesota Medical School and his colleagues decided to perform the study because they had noticed an increasing incidence of double mastectomies but could find no data about the frequency of its occurrence. Their report appeared in the Journal of Clinical Oncology.
They used data from the federal government’s Surveillance, Epidemiology and End Results cancer registry, which included information from 16 regions that represent about 26 percent of the country.
“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,” said Dr. Christy Russell of the University of Southern California ‘s Keck School of Medicine, who was not involved in the study. “It seems easier to remove everything and not have to deal with mammography screening any more.”
But people shouldn’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. “I don’t want to have to deal with the stress.”
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Growing trend
152,755
Surgeries studied for cancer in one breast, 1998 to 2003
1.8 % in 1998
4.5 % in 2003
Double mastectomies removing cancerous and healthy breasts
