The number of women with early-stage cancer involving one breast who elect to have both breasts removed has increased significantly, according to a new study of 1.2 million patients published in JAMA Surgery.
Researchers at Vanderbilt University analyzed the medical records of 1.2 million women treated for early-stage breast cancer at major cancer centers between 1998 and 2011. The proportion of women with early-stage breast cancer who elected to be treated with mastectomy in the affected breast increased from 34% to 38% during that period. A much more significant trend however was observed for women opting to receive treatment with a double mastectomy which increased from 2% to 11%.
Several clinical studies have documented that breast conserving treatment with lumpectomy plus radiation produces similar outcomes to treatment with mastectomy and the trend had been moving away from mastectomy. This study reveals a reversal of the trend toward breast conservation.
The study was unable to identify the reason for the trend toward double mastectomy but potential reasons might include improvements in breast reconstructive surgery techniques and increased fear and anxiety about experiencing a breast cancer recurrence. Another reason might be the concerns of hereditary breast cancer as a result of the BRCA genetic mutation. Unfortunately the study did not assess the reasons for the choice to undergo double mastectomy and did not collect data on the number of women who were BRCA positive or had a family history of breast cancer.
An increased awareness of hereditary breast cancer risk, acceptance of mastectomy in popular culture and improved techniques in breast reconstruction are likely factors toward the trend of mastectomy treatment of early stage breast cancer. Although there is no right or wrong decision for patients with early stage breast cancer choosing between treatment with breast conserving surgery or mastectomy, patients should ensure they are fully informed of the risks and benefits of each approach.
Reference: Kummerow K, Du L, Penson D, Shyr Y, Hooks M. Nationwide Trends in Mastectomy for Early-Stage Breast Cancer. JAMA Surg. Published online November 19, 2014. doi:10.1001/jamasurg.2014.2895