Dramatic Rise Seen in Bilateral Mastectomy for Breast Cancer


2010-11-07 13:46

A recent analysis shows a dramatic increase in bilateral mastectomy among women with cancer in one breast, despite evidence that it prolongs survival. Findings from the National Cancer Data Base (NCDB) of the American College of Surgeons (ACS) show that opting to have both breasts removed has become an increasingly popular option, especially for young insured women with breast cancer, with disease in one breast.

Though there is little evidence that having both breasts removed for cancer in one breast, the researchers say it makes sense for some women, who are becoming increasingly more aware and anxious about the disease.

Prophylactic Mastectomy Increases from 0.4 Percent to 4.7 Percent

According to senior study author David P. Winchester, MD, FACS, Medical Director of Cancer Programs at the American College of Surgeons, a surgeon at NorthShore University HealthSystem, Evanston, IL, and faculty member at the University of Chicago, “We have described a dramatic increase in the use of contralateral prophylactic mastectomy over the last 10 years. The incidence increased from a fraction of a percentage, 0.4 percent in 1998, to 4.7 percent in 2007.”

Another finding from the study included a higher rate of contralateral mastectomy that was 2.5 times more likely to be performed at academic facilities compared to small community hospitals.

The biggest increase in prophylactic mastectomy was seen in white women under age 40 who are also twice as likely to have insurance versus no insurance, Medicaid or Medicare. More than 10.5 percent had cancer in one breast.

Katharine Yao, MD, FACS, director of the breast program at NorthShore University HealthSystem, Evanston, IL, and faculty member at the University of Chicago says, "In general, the trend showed the more early stage a cancer, the higher the rate for contralateral mastectomy as compared with a later stage cancer."

A factor that might be influencing higher rates of prophylactic mastectomy among women with cancer in one breast is the availability of genetic testing. “Younger women, in particular, who have a very long life expectancy with a very long risk period—particularly those with a family history and knowing that they already have breast cancer—are making these decisions.”

Dr. Winchester notes another consideration that drives a woman’s choice is the desire for breast reconstruction and uniformity. He says, “Very often this approach makes cosmetic sense.”

The researchers say women with breast cancer need to hear their biggest risk is the cancer, not the opposite breast.

“But even without a genetic mutation and with or without a family history, the number one risk factor for breast cancer is a personal history of breast cancer,” Dr. Winchester said. With early stage noninvasive cancer of the mammary lobes and a family history, the risk of cancer can increase 2 percent a year. In a 40-year-old woman with a 40-year life expectancy, “you’re looking at a very, very high risk,” Dr. Winchester explained.

Dr. Winchester advises removal of both breasts could delay chemotherapy, “in which case I would encourage the patient not to have the contralateral prophylactic mastectomy”, that has become an increasingly popular option for women with breast cancer.

Annals of Surgical Oncology: 10.1245/s10434-010-1091-3

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