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More women with breast cancer opt to remove healthy one, study finds

Researchers find a rising trend in prophylactic mastectomy among women with breast cancer, even though there is little evidence that it actually improves survival.

September 29, 2009|Shari Roan

The choice to remove a healthy breast in order to avoid breast cancer is a deeply personal decision -- one that appears to be on the upswing in a specific segment of cancer patients, although there's little evidence to suggest it improves survival.

A study published Monday in the journal Cancer found that among women who had cancer in one breast, the number who opted to have the other breast removed, called contralateral prophylactic mastectomy, more than doubled from 1995 through 2005 in New York state.

The number of healthy women who chose to have a prophylactic mastectomy of both breasts because of a higher-than-average risk of developing cancer held steady during that time period.

The practice of removing breasts to avoid cancer is most common among women with a strong family history of the disease and who test positive for the BRCA-1 or BRCA-2 gene mutation. The new research is among the first to examine the choice of prophylactic mastectomy among women who actually did have cancer.

Lead author Dr. Stephen B. Edge, a professor of surgery and oncology at Roswell Park Cancer Institute in Buffalo, N.Y., says there are no data to demonstrate that having prophylactic mastectomy actually improves survival.

Yet the study found almost 5,000 New York women chose a contralateral prophylactic mastectomy during the 11-year period, with the number more than doubling from 1995 through 2005.

"It really increased dramatically," Edge said. "We are not making a value judgment that it is good or bad. But it's an important trend. . . . The concern is that we have women doing this out of a gut reaction. No one is really counseling women in detail about their risk. They have a 10% to 15% chance of developing cancer in the other breast in 20 years. Most likely that cancer would be detected at a very early age. So does it warrant having the breast removed?"

Said Dr. Todd M. Tuttle, chief of the surgical oncology division at the University of Minnesota and the author of a similar 2007 study: "We're not exactly certain why we're seeing this trend."

One reason is that there is increased awareness of genetic risk and of gene testing, he said. There has also been a marked improvement in mastectomy and breast reconstruction techniques.

But the trend also coincides with an increase in women who are choosing mastectomy instead of having a less-invasive lumpectomy to remove a breast tumor, Tuttle said.

"Throughout surgery, there is such a huge push to do procedures that have less scarring, the shortest surgery, the shortest recovery," he said. "That is true for everything except breast cancer."

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shari.roan@latimes.com

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