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A double mastectomy may not be the best option

September 04, 2014

While many women are opting to have a double mastectomy for early stage breast cancer, research shows the procedure is not linked to a lower risk of death than other options, such as breast-conserving therapy in conjunction with radiation.

New research

The Stanford University School of Medicine study was published in the Journal of the American Medical Association (JAMA) on Tuesday.

The authors noted 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. Yet, the number of breast cancer patients undergoing a mastectomy, in particular, a double mastectomy, is increasing.

"This is a trend that we have seen here in Western Massachusetts. Many of the women that we see who have been diagnosed with breast cancer are concerned about the future risk of breast cancer in the other (non-affected) breast and, therefore, are asking about the double mastectomy as a way to improve survival," said surgical oncologist Dr. Holly Mason, who serves as director of Breast Services at Baystate Medical Center.

"As evidenced in this study, as well as in other recent studies, this is not the case. For the individual patient, optimizing treatment of the cancer that we know about now (and not a potential future cancer) is the treatment that will improve survival," she added.

Understanding surgical risks

In an accompanying editorial addressing the study, the point was made that doctors must inform their patients of the surgical risks – especially that there is still a chance of new or recurrent breast cancer.

"This is a very important part of the surgical consultation for breast cancer. It is essential for patients to understand the multidisciplinary approach (surgery, medication, radiation) to breast cancer treatment. A more extensive surgery does not necessarily improve survival," Dr. Mason said.

The Baystate breast surgeon noted that although the idea of the double mastectomy may be appealing, it is a significantly larger surgery than breast conservation.

"We are seeing data that shows that the complication rate (the risk of bleeding, infection, wound breakdown or need for reoperation) is higher in patients undergoing the double mastectomy than in patients undergoing breast conservation or a unilateral mastectomy. In terms of breast cancer treatment, this can mean a delay in the start of the other treatment that is absolutely necessary to control the breast cancer, such as chemotherapy or radiation," Dr. Mason said.

But Dr. Mason noted the arguments over the double mastectomy do not necessarily apply to the BRCA gene mutation carriers or patients with a strong family history for breast cancer.

"For these patients, the question may be whether or not the double mastectomy should occur at the time of breast cancer treatment or at a later date, once breast cancer treatment is completed," she said.