Many breast cancer patients have their healthy breast removed along with the affected breast despite the relatively low risk of developing cancer in that healthy breast, according to a new study. The findings suggest that fear of the cancer recurring drives many women to have the aggressive surgery. But there is scant evidence that removing both breasts improves most women's long-term survival, some doctors say.
"It is not that that worry is ill-founded. It's perfectly natural for women to worry about their cancer coming back. That is [their] biggest concern," Dr. Sarah Hawley, an associate professor in internal medicine at the University of Michigan and a researcher on the study, told HuffPost. But removing most women's second breast does not improve their rates of survival, she said.
In findings that Hawley and her team will present at the American Society of Clinical Oncology's Quality Care Symposium on Friday, researchers analyzed data on 1,400 women with breast cancer who were registered with the National Cancer Institute's SEER program, which collects cancer statistics across the U.S. Approximately 7 percent of the women opted for a "contralateral prophylactic mastectomy" -- the removal of both the breast affected by breast cancer and the healthy breast.
Women who have tested positive for inherited BRCA gene mutations, which increase their risk for developing a new breast cancer in their other breast, are sometimes advised to consider contralateral mastectomy. (Some women with BRCA gene mutations who do not have cancer nonetheless opt to have one or both breasts removed as a preventive measure, which is a different procedure.)
Women with a strong family history of the disease in multiple, immediate family members may also be encouraged to consider contralateral mastectomy, Hawley said. But according to the new findings, 70 percent of the women who opted to have both their affected and healthy breast removed did not have those risk factors.
While most of the beast cancer patients in the study said that they had been worried about the possibility of their cancer recurring when making decisions about treatment, women who opted to have both breasts removed expressed the most worry -- suggesting fear may be a major reason why many women choose that aggressive option, Hawley said.
"It's not wholly unreasonable to have a bilateral mastectomy even if you don't have a [BRCA] mutation, but you need to understand that, most likely, you're not providing yourself any protection against premature death from breast cancer," said Dr. Stephen Edge, breast center medical director and chief of breast surgery at Roswell Park Cancer Institute. A recent American Cancer Society report states that contralateral mastectomy "nearly eliminates the risk of developing a breast cancer in the second breast," but cautions "there is less evidence that it improves long-term breast cancer survival."
"The risk of recurrence on the breast that had cancer, or [it] coming back elsewhere in the body from that initial cancer, is much higher than the risk of developing a new cancer in the other breast," said Dr. Carla Fisher, a breast surgeon with the Hospital of the University of Pennsylvania. "Treating the primary cancer is the most important thing, rather than treating something that may or may not happen, [which] may or may not have survival benefits down the line."
Nonetheless, recent studies suggest that the number of women in the U.S. opting to have both the affected and healthy breast removed has increased steeply over the past decade. A 2009 study in the Journal of Clinical Oncology found that the rate of contralateral mastectomy among women who had any kind of surgery on their breast increased by nearly 150 percent between 1998 and 2005. Overall, however, the rate of women choosing contralateral mastectomy is still under 10 percent among women with breast cancer.
"Most people would tell you that they've seen a marked upswing in the number of women asking for it, and the number of women undergoing it," said Edge. "Surgery is not a good treatment for fear," he added.
The "right line," Edge said, is subjective.
One concern is that women who opt to undergo contralateral mastectomy may open themselves up to various health risks associated with having a bigger operation. Those risks include infection, longer hospital stays and more difficult recovery.
For now, Hawley said, there is a pressing need to better understand the reasons why women opt for contralateral mastectomy in order to help make sure that they are adequately informed about the possible risks and benefits by their oncologists and their surgeons.
"We are sure there are a lot of other factors, other than just fear, going into this," she said. "We need to understand what those are."