Women diagnosed with breast cancer who have a mastectomy are increasingly choosing to have their other healthy breast removed as a preventive measure.
The rate of the procedure, called a contralateral prophylactic mastectomy, more than doubled from 1998 to 2003, says a study reported in the Journal of Clinical Oncology.
Study lead author Dr. Todd Tuttle, at the University of Minnesota Medical School in Minneapolis, is concerned that many women may be making the choice for inappropriate reasons, and removing the other breast may be unnecessary.
"We don't know why women are choosing this," says Dr. Tuttle. "If they are choosing it because they think it will improve their breast cancer survival, I am very concerned. It won't improve their overall survival."
Research has failed to show a survival benefit with the second mastectomy, says Dr. Tuttle. The reason: The risk of cancer spread from the original breast to other body sites often exceeds the risk of getting cancer in the second breast, he says.
Dr. Tuttle and his colleagues evaluated 4,969 women who chose contralateral prophylactic mastectomy, looking at a national database called Surveillance, Epidemiology and End Results (SEER).
From 1998 to 2003, the rate of preventive mastectomy for the second, healthy breast increased from 4.2 percent to 11 percent. Those most likely to choose the preventive operation were younger women and non-Hispanic Caucasians.
Dr. Tuttle says there are times when a second mastectomy is appropriate.
"I will tell patients to consider it strongly if they have a known genetic mutation - BRCA1 or 2 [the so-called breast cancer genes] - or a very strong family history, such as first-degree relatives who develop breast cancer before age 50," he says.
"Sometimes, we will recommend it in those who need mastectomy on one side and because of body symmetry issues, the other breast would be too big" once the cancerous breast is removed, adds Dr. Tuttle.
His advice is in line with advice from the Society of Surgical Oncology and the American Cancer Society. Many women overestimate their risk of getting cancer in the second breast, according to the Society of Surgical Oncology.
In March, a study led by researchers at Wake Forest University found that most women diagnosed with breast cancer who also chose to have their unaffected breast removed said they did not regret their decision.
And they said their quality of life equaled that of women who chose not to have a preventive mastectomy, according to the study in the Journal of Clinical Oncology.
Dr. S. Eva Singletary, at M.D. Anderson Cancer Center in Houston, Texas, says the increase in requests for the preventive mastectomies found in the new study "rings true clinically" for her patient population.
Dr. Singletary credits the increase in second mastectomies to "an improvement in breast reconstruction techniques," among other factors.
Women who opt for immediate reconstruction after a mastectomy may be more likely to choose contralateral mastectomy and get the second breast reconstructed at the same time, sometimes to achieve better symmetry, particularly if they are heavy, she says.
In a study on Vitamin D reported recently in the American Journal of Epidemiology, researchers reported that increased exposure to sunlight, which boosts vitamin D levels, may reduce the risk of advanced breast cancer in light-skinned women.
The study compared 1,788 breast cancer patients in San Francisco with a control group of 2,129 women who did not have breast cancer.
The study participants had a wide range of natural skin colors. Vitamin D may help slow breast cancer cell growth, the researchers speculate.
But the results are not an endorsement to sunbathe. Instead, they said, vitamin D from diet and supplements may someday be recommended to help reduce breast cancer risk.
Always consult your physician for more information.
There are two types of breast conservation (tissue-sparing) surgery. These include a lumpectomy and a partial (segmental) mastectomy.
A lumpectomy is the removal of the breast cancer and a portion of normal tissue around the breast cancer lump. The surgeon may also remove some of the lymph nodes under the arm to determine if the cancer has spread.
The bean-shaped lymph nodes under the arm (also called the axillary lymph glands) drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body.
Radiation therapy is often administered, following a lumpectomy, to destroy cancer cells that may not have been removed during the lumpectomy procedure.
A partial (segmental) mastectomy involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer.
The surgeon may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm.
Radiation therapy may also be administered, following a partial mastectomy, to destroy cancer cells that may not have been removed during the partial mastectomy procedure.
Mastectomy, as a non-breast-conserving procedure:
It may be recommended if the breast is very small and a lumpectomy would require removing additional breast tissue, resulting in a very deformed breast
During a total (or simple) mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and most of the overlying skin) and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands.
During a modified radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), some of the lymph nodes under the arm (also called the axillary lymph glands), and the lining over the chest muscles. In some cases, part of the chest wall muscles is also removed.
During a radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, also called the axillary lymph glands, and the chest muscles. For many years, this was the standard operation. However, today, a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.
Always consult your physician for more information.
(Our Organization is not responsible for the content of Internet sites.)