For women with early-stage, nonhereditary cancer in one breast, new research suggests a single mastectomy is more beneficial.
In the US, more and more women with early-stage breast cancer are opting for double mastectomy, or contralateral prophylactic mastectomy (CPM) - the surgical removal of both breasts - in order to reduce future breast cancer risk.
A 2014 study published in JAMA Surgery found rates of double mastectomy increased from 1.9% in 1998 to 11.2% in 2011. Despite this increase, many studies have suggested a double mastectomy does not improve survival for women in the early stages of breast cancer. What is more, researchers claim a double mastectomy raises the risk of postoperative complications.
Study leader Dr. Nicolas Ajkay, assistant professor of surgery at the University of Louisville School of Medicine in Kentucky, notes that one benefit of a double mastectomy, however, is that most women who undergo the procedure no longer require annual breast cancer screening.
Dr. Ajkay and colleagues analyzed the pros and cons of a double mastectomy and a single mastectomy, or unilateral mastectomy - the removal of only the cancerous breast - for early-stage, nonhereditary breast cancer, looking specifically at the long-term costs of each procedure and their impact on patients' quality of life.
The aim of this research was to help women with early-stage breast cancer and their surgeons make informed decisions about which procedure is best.
Single mastectomy costs less, offers better quality of life
The team reviewed a selection of recent studies that assessed the outcomes of both single and double mastectomies for women aged 50 and under with early-stage, nonhereditary breast cancer.
Using this data, the researchers investigated how each operation impacted a patient's quality of life over a 20-year period. They did so by estimating patients' quality-adjusted life years (QALYs).
The team also estimated the costs associated with a single or double mastectomy over a 20-year period, accounting for physician and mammogram fees, costs of hospitalization, cost-of-living expenses and subsequent cancer treatments.
Compared with women who underwent a double mastectomy, those who underwent a single mastectomy had a better quality of life, according to the findings.
The researchers calculated that a single mastectomy was associated with an additional 0.21 QALYs - the equivalent of an extra 3 months of improved health - over 20 years of follow-up, compared with those who underwent a double mastectomy.
Based on this finding, Dr. Ajkay says a woman who opts for a double mastectomy may experience "about 3 months of struggling with surgical complications of reconstruction, lost work productivity and significant emotional hardship."
When it comes to costs, the researchers calculated that a double mastectomy translates to an average cost of $18,577 over 20 years, while a single mastectomy - including 20 years of routine screening - costs an average of $13,525. This puts a single mastectomy's costs at over $5,000 less.
The researchers note that women who choose a single mastectomy are significantly less likely to undergo breast reconstruction than women who opt for a double mastectomy. As such, they also calculated the costs and quality of life for both single and double mastectomies assuming all women had breast reconstruction.
The team found that women who opted for single mastectomy and who underwent breast reconstruction still had a better quality of life than those who opted for a double mastectomy, and a single mastectomy still cost less.
Commenting on the findings, Dr. Ajkay says:
"Even under worst-case scenarios, we found that costs and quality of life were superior with unilateral mastectomy. With our study results, I can counsel patients that they may incur a higher cost over their lifetime with a lower quality of life for several months if they choose CPM."
The team stresses that their findings do not apply to women with hereditary breast cancer, noting that most doctors agree that a double mastectomy is largely beneficial for these patients.
Last month, Medical News Today reported on a study published in JAMA Surgery in which researchers identified a significant increase in double mastectomy among men with breast cancer.