Preventive Double Mastectomies: More Risk Than Benefit
02 July 2014 by VRP Staff
A new medical “trend” of sorts has emerged, in which perfectly healthy, cancer-free women are putting themselves through potentially disfiguring double mastectomies in the hopes of preventing breast cancer. Angelina Jolie’s announcement last year that she had this procedure after testing positive for the BRCA genetic mutation (which dramatically increases the risk of breast and ovarian cancers) has brought even more attention to this movement.
Additionally, research has shown that breast cancer patients—even those with highly treatable stage I cancer—are choosing with greater frequency to remove both breasts rather than just the affected one or undergoing a much less radical lumpectomy. In fact, researchers following 152,755 breast cancer patients for six years revealed that the decision to have a double mastectomy more than doubled within the study period.1
A Fear-Based Decision
Experts suggest that only breast cancer patients who test positive for the BRCA mutation (as Jolie did) or have a very strong family history (two or more immediate family members) consider removing both breasts as a preventive option. (Less than 10 percent of women meet one of these criteria.) Otherwise, there is no evidence that removing both breasts if you have cancer in only one will improve your chance of survival.
So what’s the reason behind this trend toward more aggressive surgery, even if it’s unnecessary? Not surprisingly, researchers have discovered that fear is a major influence.2
This study followed 1,447 breast cancer patients considering double mastectomy, unilateral mastectomy (removal of one breast) or breast conservation surgery (which includes lumpectomy and similar surgeries that preserve as much of the breast as possible). Of these women, 18.9 percent considered double mastectomy and 7.6 percent actually received it. The majority of these recipients—almost 70 percent—had no major genetic or familial risk factors that would indicate the cancer could spread to the other breast.
Furthermore, researchers discovered that women who received BRCA genetic testing were 10 times more likely to undergo double mastectomies--regardless of the result! Other aspects strongly associated with opting for surgery included higher education and worry about recurrence. The researchers stated, “Worry about recurrence appeared to drive decisions for [double mastectomy] although the procedure has not been shown to reduce recurrence risk.”
What Should You Do?
No one will deny that any cancer diagnosis can cause extreme fear and anxiety. But you can’t let these emotions drive you to make a decision that you ultimately cannot “unmake.” The first step toward understanding the true risks associated with your particular health situation should entail a very in-depth conversation with your oncologist. (Get second and third opinions as well.)
In reality, for most breast cancer patients, there’s a greater chance of cancer spreading from the breast to other parts of the body, rather than to the other breast. Just knowing this one fact alone could sway thousands of women from mastectomy to less extreme options.
Furthermore, genetic testing for the BRCA mutation, as the above study has indicated, can lead to unnecessary surgery and should be reserved for the very small minority of women who really fall into the appropriate risk profile. Earlier this year, the U.S. Preventive Services Task Force recommended against genetic counseling or BRCA testing “for women whose family history is not associated with an increased risk for potentially harmful mutations” of these genes.
For truly at-risk women, they recommend screening first, to identify if family history may be connected to harmful genetic mutations. Only then should women with positive screening results receive genetic counseling, then if indicated after counseling, genetic testing.3
Natural Prevention
Regardless of risk factors, all women—just by nature of being female—have some possibility of developing breast cancer. For this reason alone, everyone should practice prevention measures.
In addition to exercising regularly and eating a well-rounded diet free of sugar and processed foods, consider taking breast-protective supplements. Ask a alternative nutritional practitioner for guidance on which to take.
STRESS
Finally, don’t underestimate the importance of stress reduction. Meditation, yoga, tai chi, massage, acupuncture, acupressure, deep breathing and professional counseling/therapy are all excellent ways to control stress and improve overall health.
References:
- Tuttle TM, et al. J Clin Oncol. 2007 Nov 20;25(33):5203-9.
- Hawley ST, et al. JAMA Surg. 2014 May 21. [Epub ahead of print.]
- Moyer VA. Ann Intern Med. 2014 Feb 18;160(4).