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Making Decisions About Breast Cancer Surgery


American Cancer Society (cancer.org)

October 27, 2014

By Stacy Simon

Most women with breast cancer have some type of surgery as part of their treatment. They often have choices to make about the type of surgery they will undergo.

For example, many women with early-stage cancers can choose between breast-conserving surgery and mastectomy. The main advantage of breast-conserving surgery (also called lumpectomy) is that a woman keeps most of her breast. However, she will in most cases also need radiation. Studies have shown that this type of treatment gives women with breast cancer at least as good a chance of survival as mastectomy, which removes the entire breast.

But more and more, women in the US who are diagnosed with early-stage breast cancer on one side are choosing to treat it with double mastectomy - surgical removal of both breasts. Women who choose this option may do so believing it will give them the best chance of survival by getting rid of their cancer and preventing a second cancer. But researchers from California have found that double mastectomy does not provide an increased chance of survival over the next 10 years as compared to breast-conserving surgery.

The study was published September 2, 2014 in the Journal of the American Medical Association. It compared 10-year survival rates after the 3 most common types of breast cancer surgery: mastectomy, double mastectomy, and breast-conserving surgery.

The researchers examined records of 189,734 women in the California Cancer Registry who were diagnosed with early-stage cancer in one breast between 1998 and 2011, and who were eligible for breast-conserving surgery. They found the rate of double mastectomy increased from 2% in 1998 to 12.3% in 2011. When they looked at only women under age 40, the rate increased from 3.6% to 33%. They found similar survival rates -over 80% - for double mastectomy and breast-conserving surgery followed by radiation. However, single mastectomy was associated with slightly lower survival rates.

Over-treatment concerns
In the study, women who chose mastectomy - removing the one affected breast - had slightly worse 10-year survival rates than women who chose breast-conserving surgery. While the reasons are not certain, the authors point out that mastectomy is more common among women with lower income and who do not have private medical insurance - factors that are known to affect survival rates.
Also unclear is why more women are choosing to remove not only the breast with cancer, but the other breast as well. According to the authors, the trend raises concerns over possible over-treatment. Double mastectomy is associated with higher costs, longer recovery, and greater risk of complications. What's more, there is no evidence that removing the other breast helps most women live longer. An exception may be women at very high risk for a second cancer because they were diagnosed at a young age or have a gene mutation that strongly raises cancer risk, such as mutation in one of the BRCA genes.

The researchers say one reason for the trend may be fear of getting cancer again, although they say the fear usually is greater than the risk. Another reason may be cosmetic. Women choosing double mastectomy may want to take advantage of newer breast reconstruction techniques, and have both breasts done at the same time.

Whatever you decide, be sure to get all the facts. A cancer diagnosis almost always makes people feel like they have to start treatment as soon as possible. But for early stage breast cancer, you have time to think through all your options so you can make the best possible choice. It is important that you don't rush into making a decision, but instead take your time deciding what type of surgery is right for you.

Citation: Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for breast Cancer in California, 1998-2011. Published September 2, 2014 in the Journal of the American Medical Association. First author Allison W. Kurian, MD, Stanford University, Stanford, Calif.
Reviewed by: Members of the ACS Medical Content Staff

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