Rates of Preventive Mastectomies Rising

Younger women with breast cancer increasingly opting for prophylactic mastectomy over lumpectomy

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

(RxWiki News) More women are choosing an aggressive treatment option for a diagnosis of breast cancer. And this trend is rising fastest in a certain group of women.

To track trends in treatment of early stage breast cancer, a research team reviewed a large database of information to find which type of surgery women chose as their treatment.

The results showed that, when cancer was found in one breast, more young women than in previous years were choosing to have both breasts removed.

"Ask your oncologist about breast cancer treatment options."

Katherine Yao, MD, FACS, and a research team from the Department of Surgery of the NorthShore University HealthSystem in Evanston, IL conducted this data review.

The research team reviewed a database of records of 553,593 women who were diagnosed with early stage breast cancer between 2003 and 2010. The women either had a lumpectomy (the cancerous tumor was removed), a mastectomy (the affected breast was removed) or a contralateral prophylactic mastectomy (CPM; where both the affected and unaffected breasts were removed).

The researchers also collected information on other factors, such as age of the patients, tumor types and area of the country where the patient lived.

From 2003 to 2010, lumpectomy rates dropped slightly from about 68 percent of women making this choice in 2003 to 66 percent in 2010. Rates of removal of one breast dropped from 28 percent to 24 percent over this time period.

The number of women who chose CPM rose from 4 percent in 2003 to nearly 10 percent in 2010. When choices of only women ages 41 to 45 were analyzed, the results showed a 16 percent increase in rates of CPM from 2003 to 2010.

In 2010, about 20 percent of women between the ages of 41 and 45 chose CPM, while 5 percent of women 66 to 70 made this choice. The statistics for lumpectomies showed that 54 percent of younger women chose lumpectomy, while 73 percent of older women made this choice.

In the group of women between the ages of 41 and 45, more of the women who lived in the Midwest had a CPM, compared with 15 percent of the women in the Northeast.

This research article reported that even though a third of women felt self-conscious after their CPM and 42 percent reported that their sense of sexuality was worse, women still remarked that they were satisfied with their choice to have a CPM and would make the same decision again.

The authors cited other research in which most women said they had the CPM to “lower their chance of getting cancer in the other breast.” The women also said they didn’t want to have to “worry about getting another breast cancer.”

Despite these beliefs, the authors wrote that the chance of getting cancer in the other breast was only 3 percent in five years and 6 percent at 10 years. They also explained that these rates have been dropping due to the development of more effective treatments.

“These knowledge gaps provide opportunities for surgeons to develop educational materials and decision tools that will more accurately inform patients of the contralateral [opposite] breast cancer risk, the lack of a survival benefit of CPM, and the psychosocial ramifications of CPM especially in young women,” the authors concluded.

"This article brings up a phenomenon surgeons have seen across the country — the increased use of single or double mastectomy for early breast cancer. Typically the patient does not require a mastectomy for treatment, when she could have a medically appropriate lumpectomy. Yet many women arrive at their surgeon’s office for their first visit convinced that they should have a mastectomy," said Cary S. Kaufman MD, FACS, Associate Clinical Professor of Surgery at the Bellingham Breast Center in Bellingham, Washington.

"Certainly, many young women have larger, more aggressive cancers than those found in older women. But the incidence of these larger aggressive cancers has not changed during this time period, thus do not provide an explanation for these findings," Dr. Kaufman told dailyRx News.

"This concept has been fueled by social media, spreading the thoughts described in the article — to be sure, have a mastectomy. These thoughts are more widely spread in the younger age group than older age group," he said.

"Although this concept has been fueled by the Angelina Jolie event (which isn’t related since she had the BRCA gene), it seems as though this interest in bilateral mastectomies seems to be waning. Like any popular fad, this will lose its luster and fade over time," Dr. Kaufman said.

This research was published in the April issue of the Journal of the American College of Surgeons.

The authors declared no conflicts of interest.

Review Date: 
April 17, 2014
Last Updated:
May 7, 2014