Can Double Mastectomies Improve Survival Rate?

A mastectomy is surgery for removal of one or both the breasts, usually in the treatment of breast cancer. In most cases, the breast with the tumor is taken out sometimes along with nearby tissues but in certain cases, the oncologist may advise you to have both the breasts removed, either if the cancer has spread or as a precautionary measure in women at high risk. Women with breast cancer and a known BRCA mutation are at a very high risk for a second cancer. In this case, they may have to go in for double mastectomy – that is removal of the breast with cancer and also the normal breast to bring down the risk of a second breast cancer.

What is double mastectomy surgery?

Mastectomy is removal of the whole breast in which all the tissues are removed but an alternative to this is breast-conserving surgery, or BCS, which involves removal of only a part of the breast, that is only the section which has the tumor. In some instances, BCS will require breast reconstruction surgery which may be carried out at the time of removal or at a later stage. However, those who choose to go for BCS will, in a majority of the cases, need to undergo radiation for five to six weeks to kill the remaining cancer cells.

Recent studies have indicated that more and more women are opting for double mastectomy in order to ‘minimize’ the risks of cancer recurrence. This is especially with women who are very young and even those whose cancer is in an early and very treatable stage. They opt to remove not only the breast which has the cancer but also the other one in the belief that this may prevent the occurrence of a second cancer.

Even though more and more women are opting to have bilateral mastectomy or double mastectomy,there are no studies to indicate that the survival rate improves if both breasts are removed. Those who go in for double mastectomy stand as much a chance of getting cancer again as those who have had partial breast surgery.

Is double mastectomy Necessary?

Experts say that bilateral mastectomy does not give you any better possibility of long-term survival or improved result from treatment even when breast-conserving surgery or single mastectomy can be done.

Doctors are concerned that women go for double mastectomy in the mistaken belief that it will eliminate their future risk of cancer.

Studies seem to indicate that women who have had BCS or lumpectomy suffer the same fate as those with a double mastectomy. And the disadvantage in the latter case is that they not only have to go through a major surgery to remove both the breasts but also lose a healthy one. Plus there will be complications and side effects generally associated with major surgeries. The patient will require significant mastectomy recovery time and may need a breast reconstruction after mastectomy. In comparison, a lumpectomy is much less invasive, the recovery time faster and chances of complications much less.

Double mastectomy - the Angelina Effect

It is believed that ‘The Angelina Effect’ could be responsible for this rise in the number of women who want both breasts removed. In 2013, Hollywood star Angelina Jolie had a double mastectomy done after she was diagnosed with a defective BCRA 1 gene which significantly raised her risk of developing breast cancer.

Toronto’s Sunnybrook’s Odette Cancer Centre reported a 90 percent increase in the number of women who came for breast cancer genetic screening at the center six months before and after Jolie’s announcement.

Rise in number of bilateral mastectomy

And this number continues to go up. Research shows that the number of women younger than 40 who are choosing double mastectomy is going up by 17.6% annually. In 1998 the figure was 3.6% and in 2011 it had risen to 33%. This definitely is a significant rise. Across age groups, the percentage of patients going for bilateral prophylactic mastectomy rose from 2% in 1998 to 12.3% in 2011. This means an annual increase of 14.3%.

This data, however, does not indicate that the increase in percentage is because it has been proved that bilateral mastectomy increases survival rate in comparison. On the contrary, a study noted that a research which studied women with cancer in one breast between 1998 and 2011 found that the difference in survival rate between those who went in for lumpectomy followed by radiotherapy and those who opted for double mastectomy was not statistically significant. This indicates that having bilateral mastectomy with the purpose of lowering the risk will not necessarily pay off. However, the study did find out that the survival rate among those with unilateral mastectomy, or those who went in for single breast removal, was lower. This, say researchers, is more likely to be because of other unrelated reasons.

Over-treated with double mastectomy?

Experts say that bilateral prophylactic mastectomy may reduce risk of a new breast cancer occurring but does not lower the risk of other organs getting it if the cancer is metastatic. And if bits of breast tissue remain in the chest wall even after double mastectomy, there is a chance of the cancer recurring.

Therefore, doctors are ‘concerned’ about this misconception in women which is leading to them being ‘over-treated’. They recommend that patients should be given detailed explanation about the surgery options before them and there should be clear communication from her doctor about what expectations to keep.

 


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