Double Mastectomy

Double Mastectomy

A double mastectomy is sometimes performed even when only one of the breasts is affected by cancer. In these cases, the decision to remove the tissue from both breasts as opposed to only the one containing cancer cells is largely preventative. Some patients may even have the preventative mastectomy in the absence of cancer. This may include patients who carry a gene mutation that makes them high risk for developing breast cancer or patients who have a strong family history of breast cancer and want to take measures to avoid developing breast cancer in the future. 3

The overall rate of double mastectomy - that included removal of an unaffected breast climbed from 1.8 percent in 1998 to 4.5 percent in 2003, the report indicates. Among mastectomy patients, the rate rose from 4.2 percent to 11.0 percent. These trends were noted for patients at any cancer stage and were still apparent at the end of the study period. 6

In October, she had a double mastectomy and her cancer went into remission. Courtois again visited the PERC and was able to get a breast prosthesis free of charge. 2

The findings stem from a study of 483 women with BRCA mutations who were followed a mean of 6.4 years to assess breast cancer occurrence. The subjects included 105 who elected to undergo bilateral prophylactic mastectomy and 378 matched controls who did not. 4

The large study (more than 150,000 patient histories were reviewed) reviewed here found that more women chose to have both breasts removed — even though cancer had been found in only one breast — between 1998 and 2003. Surgery to remove both breasts is called double or bilateral mastectomy. 10

While slightly more than 50% of women who learned that they carried one of the BRCA mutations opted for a double mastectomy in the Lancet study, it’s clearly not the only option. Even when breast cancer does occur, tumors in women with BRCA mutations aren’t any more virulent than cancers in other women, says Anne Blackwood, MD, an assistant professor of medicine and epidemiology in the division of hematology and oncology at the University of Pennsylvania Medical Center in Philadelphia. If the cancer is caught early, a simple lumpectomy — where doctors remove the cancerous mass but leave the rest of the breast intact — may suffice. 8

A study published in the January 14, 1999 issue of the New England Journal of Medicine found that women with a strong family history of breast cancer (not specifically those who tested positive for the breast cancer gene) reduced their risk of developing the disease by 90% if they had both breasts removed. Though having a double mastectomy is not an absolute guarantee that a woman will stay cancer-free, the 10% who did develop tumors after the surgery may have had undetected cancers at the time of the operation, Vogel says. 7

Indeed, a woman makes the decision to have her breasts removed in the face of horrifying odds. Although mutations of the BRCA-1 or BRCA-2 genes do not guarantee that a woman will develop breast cancer, they substantially raise her risk. Women with BRCA mutations run a lifetime risk as high as 4 in 5 of developing the disease, says Victor Vogel, MD, director of the Comprehensive Breast Program at the University of Pittsburgh Cancer Institute/Magee Women’s Hospital. Their lifetime risk of developing ovarian cancer is also elevated to 2 in 5. In comparison, about 1 in 8 women in the general population will develop breast cancer in their lifetimes, many in old age, and only 1 in 100 will have ovarian cancer, says Vogel. 5