(NaturalNews) Increasing numbers of women are choosing to have both breasts removed in order to avoid breast cancer -- but doctors warn that many of these procedures may expose women to serious risk without providing the promised benefit.
In general, two kinds of women use double mastectomy as a preemptive breast cancer treatment. One group consists of women who have been diagnosed with cancer in one breast and choose to have both breasts completely removed in order to avoid the risk of developing cancer in the healthy breast. This procedure is called contralateral prophylactic mastectomy. Another group, the so-called "pre-vivors," are women who have not received a cancer diagnosis at all but believe they have a high enough cancer risk to justify the measure.
Performing mastectomies as prophylaxis was uncommon just a few decades ago, but the popularity of the practice has risen sharply in recent years.
"For the past 20 years we have moved toward less invasive surgery with lumpectomy and radiation instead of total mastectomy," said surgeon Walter "Bo" Blessing of Surgical Associates in Charleston, S.C. "However, in the last three to five years, with the advent of new reconstructive techniques and breast MRI, more women are choosing mastectomy."
Most insurers will pay for either single or double mastectomy, even without a cancer diagnosis in both breasts.
According to a study conducted by researchers from the University of Minnesota and published in the Journal of Clinical Oncology< in 2007, contralateral prophylactic mastectomy rates in the United States increased 150 percent between 1998 and 2003. The Vanderbilt-Ingram Cancer Center in Nashville, Tenn., reports a fivefold increase in the practice in recent years.
Statistics from the National Cancer Institute's Surveillance, Epidemiology, and End Results database reveal that it is mostly younger women choosing prophylactic mastectomies. As new diagnostic techniques continue to detect cancers earlier, the rates of preventive mastectomy are only inspected to grow.
"Women today are more educated about their risk factors, and we understand genetics better," said Valerie Gorman, a breast surgeon at Baylor Medical Center in Waxahachie, Texas, who reports increasing numbers of women coming to her for preventive mastectomies. "Plus, genetic testing is easier than in the past, and plastic surgery reconstructive procedures are more accessible."
The genetic tests that Gorman references screen mostly for mutations in the tumor-suppressing BRCA1 or BRCA2 genes; having a mutation in either gene can increase a woman's breast cancer risk by 80 percent. In other words, an otherwise healthy woman with such a mutation would have a breast cancer risk of 22 percent, rather than the average of 12.5 percent. Bilateral mastectomy can cut this risk by about 90 percent -- bringing it, in the case of the "average" woman cited above, to about 2 percent.
In the case of "pre-vivors," the presence of these mutations alone may be enough to convince some women to choose double mastectomy. Women with a cancer diagnosis in one breast may also choose mastectomy if they have genetic or other risk factors, or if they are concerned about the elevated risk that comes from already having had cancer once. "Most of my patients that proceed with bilateral mastectomy tell me that they did not want to have to worry about further monitoring of the opposite breast," said surgeon Gretchen A. Meyer. Another commonly cited reason for a double mastectomy is the desire for breast symmetry, which may be easier to achieve if both breasts are removed and reconstructed at the same time.
But some doctors warn that many of the procedures are unnecessary, that their risks are downplayed and their benefits are exaggerated.
The contribution of the BRCA genes to cancer risk may have been blown out of proportion, for example: only 5 to 10 percent of breast cancers are attributed to genetic causes. Likewise, the risk of cancer recurrence in an opposite breast normally comes to only 0.5 to 1 percent per year. Cancer cells typically spread through the circulatory or lymph systems, meaning that cancer is more likely to recur in a different body part than in the contralateral breast.
According to Ingrid Meszoely, clinical director of the Vanderbilt Breast Center, new screening techniques such as magnetic resonance imaging (MRI) are detecting small abnormalities that might not actually be cancerous or have anything to do with cancer risk. This, she suspects, has led more women to turn to aggressive treatments.
The benefits of the procedure have likewise been exaggerated, doctors say: double mastectomies cannot prevent cancer.
"Some people think, 'If I do [bilateral] mastectomies, I'll never have to worry about breast cancer again,'" Meszoely said. "Just because you do a mastectomy doesn't mean your risk of developing breast cancer is zero. You can't remove all the breast tissue from the chest wall."
Perhaps most fundamentally, there is no evidence that double mastectomy increases women's survival rates. "The survival in national trials is exactly the same for people who have a lumpectomy followed by radiation as opposed to a mastectomy," Meszoely said. Finally, the procedure carries definite risks: Beyond its effects on self-image or sexual intimacy, the removal of even one breast can lead to chronic pain and decreased upper body mobility. This risk roughly doubles when both breasts are removed.
Eric Winer, director of the Breast Oncology Center at Dana-Farber Cancer Institute in Boston, said that given the pace at which medical knowledge changes, he does not advise people to take extreme, irreversible measures to try and avoid all risk of disease.
"But we have no idea where we're going to be in terms of medical science," Winer said. "I don't think when people are contemplating decisions they should think about lifetime risk. I think they should think about their risk over the next decade.''
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