Doubling Down on Double Mastectomies

Breast cancer patients increasingly choosing contralateral prophylactic mastectomy

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Learning you have breast cancer can be shocking and life-changing. Some women don’t ever want to go through the experience again and choose to have both of their breasts removed to protect themselves, even if the cancer is limited to only one breast. A new study looked at the survival benefits of such a decision.

After reviewing data on more than 100,000 women, researchers have estimated that having the healthy breast removed could help early breast cancer patients live six months longer.

This procedure is called a contralateral prophylactic mastectomy (CPM), and rates of this operation have doubled in recent years.

dailyRx News spoke with a breast surgeon who said the decision to have both breasts removed isn’t about survival.

"Thoroughly discuss your cancer surgery options."

Todd M. Tuttle, MD, FACS, chief of surgical oncology at the University of Minnesota in Minneapolis, and colleagues conducted this study to learn the survival impact of CPM among women without BCRA genetic mutations that substantially increase breast cancer risks.

“In patients who don't have a strong family history, after being diagnosed with breast cancer, many women worry about developing breast cancer in the other breast. Over a lifetime, about 20 percent of diagnosed patients will develop a second breast cancer,” Cary Kaufman, MD, a breast surgeon and specialist at Bellingham Regional Breast Center in Bellingham, WA, told dailyRx News.

For this study, the research team analyzed data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) and the Surveillance, Epidemiology, and End Results (SEER). Information on more than 100,000 women between the ages of 40 and 60 who had participated in clinical trials over the previous 30 years was analyzed. None of the women had BRCA gene alterations.

The scientists performed what’s known as an analytic modeling to estimate life expectancy benefits.

Investigators divided the data by age, stage of disease and estrogen-receptor status. They found that women with stage l, estrogen-receptor negative breast cancer benefited the most from having the healthy breast removed. These women lived just over six months longer than women who had not had the double mastectomy.

This was the maximum life extension among all groups, regardless of age, disease stage or estrogen receptor status.

Dr. Tuttle said in a prepared statement, “This information may ultimately help them answer an important question: 'If I have that opposite breast removed, is that procedure really going to improve the likelihood that I will be alive 10 to 20 years from now?'"

Dr. Kaufman said the decision to have a double mastectomy isn’t about living longer.

“The issue of CPM is that most women wish for the emotional freedom of not worrying about the other breast. Although it might not save days of life, it is effective at preventing second breast cancers. Even though the second cancer may be found smaller and earlier than the first due to close follow-up, they still have to go through the treatment if it is diagnosed. Avoiding that process is the freedom that CPM provides,” Dr. Kaufman said.

“They may not wish to live longer; they wish to live ‘better’ without worry or yearly mammograms. The emotional weight and burden of not worrying about the second breast is the reason many women choose this method. This is not the way doctors look at this decision, but this is the way women may look at the decision. Emotional health over physical health,” he said.

Findings from this research were presented at the 2013 Clinical Congress of the American College of Surgeons.

Review Date: 
October 7, 2013
Last Updated:
October 7, 2013