Having a double mastectomy for early-stage breast cancer is not linked to a lower risk of death than breast-conserving therapy plus radiation, but still there is an increase in the number of women undergoing the procedure. These are the findings of a new study published in JAMA.
This is not the first study to question the benefits of a double mastectomy, or bilateral mastectomy - the removal of both breasts - for breast cancer patients. Earlier this year, Medical News Today reported on a study published in JAMA Surgery claiming the procedure is unnecessary for the majority of women.
The researchers of this latest study, including Dr. Alison W. Kurian of the Stanford University School of Medicine, CA, note that previous research has shown that patients with early-stage breast cancer have similar survival rates whether treated with a combination of breast-conserving therapy and radiation or a mastectomy.
However, they point out that other studies have indicated the number of breast cancer patients undergoing a mastectomy, particularly a double mastectomy, is increasing.
For their study, Dr. Kurian and colleagues wanted to better determine the rate of breast cancer patients undergoing a double mastectomy and further investigate whether the procedure has benefits over other treatments.
"Because bilateral mastectomy is an elective procedure for unilateral breast cancer (cancer in one breast) and may have detrimental effects in terms of complications and associated costs as well as body image and sexual function, a better understanding of its use and outcomes is crucial to improving cancer care," say the researchers.
The risk-benefit ratio of double mastectomy 'warrants careful consideration'
The team analyzed data from the population-based California Cancer Registry, identifying 189,734 women who were diagnosed with early-stage unilateral breast cancer between 1998 and 2011. Patients were followed-up for an average of 89.3 months.
The researchers found that the rate of bilateral mastectomy among these women increased from 2% in 1998 to 12.3% in 2011, representing an increase of 14.3% every year. The highest increase was seen among women aged 40 and under; the rate of bilateral mastectomy in this population increased from 3.6% in 1998 to 33% in 2011, an increase of 17.6% each year.
The overall rate of unilateral mastectomy - the removal of one breast - declined during this period.
Non-Hispanic white women were most likely to have a double mastectomy, as were women who received care at a National Cancer Institute-designated cancer center and those with private medical insurance. Unilateral mastectomy was most common among women with Medicaid and racial/ethnic minorities.
In addition, Dr. Kurian and colleagues found that women who underwent a bilateral mastectomy had no lower risk of death than women who had breast-conserving therapy with radiation. However, a unilateral mastectomy was linked to higher mortality.
Commenting on their findings, the researchers say:
"In a time of increasing concern about overtreatment, the risk-benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient's preference for a morbid, costly intervention of dubious effectiveness.
These results may inform decision-making about the surgical treatment of breast cancer."
In an editorial linked to the study, Dr. Lisa A. Newman, of the University of Michigan-Ann Arbor, says that when women receive a breast cancer diagnosis, many assume they will increase their chance of survival by taking the most aggressive surgical option. She says this has likely driven the increase in rates of bilateral mastectomy.
However, she notes that these patients need to be informed of the risks this surgery incurs, and be told that there is still a chance of new or recurrent breast cancer.
"The need for patients to be accurately informed regarding safe and oncologically acceptable treatment options is indisputable," she adds.
"The dense fog of complex emotions that accompanies a new cancer diagnosis can impair the ability to process this information. Patients should be encouraged to allow the intensity of these immediate reactions to subside before committing to mastectomy prematurely."
Last year, a study reported by Medical News Today suggested that fear may be driving young breast cancer patients to have needless mastectomies.