It appears many women opt for a double mastectomy when they are diagnosed with cancer in just one breast, and that number has significantly increased since the 1990s. (One percent of women chose prophylactic mastectomy back then opposed to 20 percent in recent years.) But in a new study published in JAMA Surgery, researchers say that “preventative” measure is unnecessary in 70 percent of breast cancer surgeries.
Studies don’t show that removing an unaffected breast can lower a woman’s risk of recurrence or increase her chances of surviving the disease, so leading experts have identified four other reasons guiding women’s choices.
- A fear of doing nothing. “Fear is absolutely driving the decision,” says Dr. Isabelle Bedrosian of the University of Texas MD Anderson Cancer Center. This is especially true of women who have already undergone chemotherapy. “I definitely understand that fear; we often hear, ‘I don’t want to deal with this ever again,’” Bedrosian says. But as the current JAMA study found, only 10 percent of women who are diagnosed should consider a double mastectomy. For the other breast cancer patients, recurrent tumors are more than likely to develop in the liver, lungs, or brain.
- Early detections means too much information. More women are getting an MRI of the breast, which detects images refined enough to pick up the tiniest of lesions, including those that may not need treatment. Most women won’t ignore anything that remotely looks abnormal.
- The pink ribbon brigade. Breast cancer awareness plus coverage of celebrities’ decisions to proactively remove their breasts have magnified the obligation and responsibility behind every choice. “There is a hyper awareness surrounding prophylactic mastectomy, and many women are choosing it without a clear understanding of why,” says Bedrosian.
- Not enough accurate information about options. Doctors simply don’t have the best tools to help patients make this decision. Ten percent of women are at high risk for having recurrent breast cancer, but what about the other 90 percent who may not have a genetic risk? The decision becomes harder. “Communication is important to make sure that patients are informed about the medical facts,” says Bedrosian. “It’s important to make sure that our patients are making informed choices and not simply fear-driven choices.”