Removing healthy breast is unlikely to extend survival, but some doctors don't mention this, researchers say
By Kathleen Doheny
WEDNESDAY, Dec. 21, 2016 (HealthDay News) -- Many women with early stage breast cancer choose to have their healthy opposite breast removed, even when there are no medical indications that such a step is necessary, a new survey finds.
That's especially true when the surgeon doesn't offer a recommendation either way, the researchers said.
"We are seeing that one in six breast cancer patients are choosing bilateral mastectomy when this aggressive procedure is not going to benefit them in terms of survival," said Dr. Reshma Jagsi.
Jagsi, who led the study, is a professor and deputy chair of radiation oncology at the University of Michigan School of Medicine.
Cancer specialists say no compelling evidence suggests a survival advantage for most patients to chose a double mastectomy. Also, the risk of getting cancer in the opposite healthy breast is low for most patients, they note.
However, after actress Angelina Jolie publicized her decision to undergo removal of both breasts, more women became aware of the option. Perhaps they think more is better, the researchers said.
Jagsi said she is disturbed that so many women choose such a radical approach. However, she understands how they perceive they are doing everything they can to avoid cancer.
Women for whom the double procedure might be warranted, she said, include those who have a very high cancer risk, such as the BRCA 1 or BRCA 2 gene mutations.
However, "for women with garden-variety breast cancer in one breast, the medical risks [of a preventive mastectomy in the opposite breast] really seem to outweigh the medical benefit," Jagsi said.
In the study, Jagsi and her colleagues surveyed 2,400 women diagnosed with early stage breast cancer in one breast. The researchers asked how their surgeon's recommendation -- or lack of one -- affected their decision for or against removal of the healthy breast.
Overall, the researchers found, 44 percent of the patients said they had considered removal of the healthy breast, but only 38 percent knew the procedure does not improve survival for all women with breast cancer. Nearly one-quarter believed it did, while the others didn't know.
About 1,500 patients did not have a high genetic risk of an identified mutation that raised risk of breast cancer. Thirty-nine percent of this group said their surgeon recommended against removal of the healthy breast. In the end, less than 2 percent of these women had the more aggressive procedure.
However, 47 percent of the average-risk women received no recommendation either way about removal of the healthy breast. Among these women, 19 percent decided to undergo a double mastectomy.
Nearly all who chose to have the unaffected breast removed cited peace of mind as the primary reason, the researchers found.
The study results were published Dec. 21 online in JAMA Surgery.
Surgeons need to communicate the risks and benefits with each patient, Jagsi said. "What we need to do as physicians is educate our patients," she said.
Other researchers have also found that women are increasingly opting for preventive mastectomy. What appears new in this study is the physicians' influence on patients' decision-making, said Dr. Courtney Vito. She's a breast surgeon and assistant clinical professor of surgical oncology at City of Hope Comprehensive Cancer Center in Duarte, Calif.
Helping patients make the right decision for their situation takes time and effort, said Vito, who wasn't involved in the study. It means developing a rapport and bond with a patient, she added.
"When you actually sit down and educate your patients, then they can make an appropriate decision," Vito said. In some cases, she hasn't agreed with a patient's choice, "but the woman made an informed decision," she added.
"My job is to demonstrate to the patient what the entire road map is," Vito said. In her opinion, with physician guidance, a woman undergoing breast cancer treatment "should be ultimately satisfied with her decisions, because they are truly hers and she is making them in an informed way."
To learn more about preventive mastectomy, see the Society of Surgical Oncology.
SOURCES: Reshma Jagsi, M.D., D.Phil., professor and deputy chair, radiation oncology, University of Michigan, Ann Arbor; Courtney Vito, M.D., breast surgeon and assistant clinical professor, surgical oncology, City of Hope Comprehensive Cancer Center, Duarte, Calif.; JAMA Surgery, Dec. 21, 2016
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