Some Women with Breast Cancer Choose to Have an Unnecessary Mastectomy

According to one recent study, one in six women with breast cancer chooses to have a healthy breast removed even when there’s no indication that a double mastectomy will improve her odds of survival.

In the study, published in JAMA Surgery, researchers sent a survey to more than 3,600 women, 2,578 of whom responded. Ninety-three percent of respondents had been diagnosed with early stage breast cancer in one breast and the average age of respondents was about 62 years old. Researchers wanted to assess how often women with breast cancer follow their surgeon’s advice when he or she doesn’t recommend removing the healthy breast and how often surgeons actually make a recommendation against this aggressive approach in the first place.

Researchers discovered that nearly 44 percent of the women considered removal of their healthy breast, with about 25 percent of these women considering it strongly or very strongly. However, only 38 percent knew that a contralateral prophylactic mastectomy, a procedure that involves removal of a healthy breast, didn’t improve survival for breast cancer patients. Twenty-five percent of patients thought that the procedure did increase survival, while other respondents were unsure.

Of the women surveyed, 62 percent underwent breast-conserving surgery, which removes only part of the breast tissue; 21 percent underwent a unilateral mastectomy, or removal of one breast; while 17 percent chose contralateral prophylactic mastectomy and removed both breasts, including the healthy breast.

Of these women, 1,500 did not have a genetic mutation-related risk factor for breast cancer, and 39 percent also admitted that their surgeon advised against removal of the healthy breast. Less than 2 percent of these women proceeded with the aggressive procedure against their doctor’s orders.

However, the researchers also found that the lack of a doctor’s recommendation caused more women to undergo the more aggressive, unnecessary procedure. Forty-seven percent of average-risk women didn’t receive a recommendation from their doctor about whether or not to remove their healthy breast, and 19 percent of these women went ahead and had a double mastectomy.

Patients really need to understand the underlying data and research about this approach and make an informed decision. However, the study shows there’s a gap in patient education regarding this topic that we as doctors need to fill. The researchers said many patients consider the more aggressive approach, but knowledge about the procedure is low among patients. This research indicates that when doctors give no recommendation, it’s left to the patient to draw her own conclusions and this often this leads to the wrong choice, unnecessary medical procedures and overtreatment — not to mention a longer recovery and reconstruction process and potential disfigurement of the breasts.

We’ve seen rates of contralateral prophylactic mastectomy increase over the years, but the one thing I stress to patients is that it’s not the kind of surgery that determines their risk of recurrence, it’s what we do to treat the cancer to prevent it from coming back.