Friday, January 6, 2017

Many with Breast Cancer Unnecessarily Choose Double Mastectomy

Many women with early stage breast cancer choose to have their healthy opposite breast removed, even when there are no medical indications that such a step is necessary, a new survey finds.

That’s especially true when the surgeon doesn’t offer a recommendation either way, the researchers said.

“We are seeing that one in six breast cancer patients are choosing bilateral mastectomy when this aggressive procedure is not going to benefit them in terms of survival,” said Dr. Reshma Jagsi.

Jagsi, who led the study, is a professor and deputy chair of radiation oncology at the University of Michigan School of Medicine.

Cancer specialists say no compelling evidence suggests a survival advantage for most patients to choose a double mastectomy. Also, the risk of getting cancer in the opposite healthy breast is low for most patients, they note.

However, after actress Angelina Jolie publicized her decision to undergo removal of both breasts, more women became aware of the option. Perhaps they think more is better, the researchers said.

Jagsi said she is disturbed that so many women choose such a radical approach. However, she understands how they perceive they are doing everything they can to avoid cancer.

Women for whom the double procedure might be warranted, she said, include those who have a very high cancer risk, such as the BRCA 1 or BRCA 2 gene mutations.

However, “for women with garden-variety breast cancer in one breast, the medical risks [of a preventive mastectomy in the opposite breast] really seem to outweigh the medical benefit,” Jagsi said.

In the study, Jagsi and her colleagues surveyed 2,400 women diagnosed with early stage breast cancer in one breast. The researchers asked how their surgeon’s recommendation – or lack of one – affected their decision for or against removal of the healthy breast.

Overall, the researchers found, 44% of the patients said they had considered removal of the healthy breast, but only 38% knew the procedure does not improve survival for all women with breast cancer. Nearly one-quarter believed it did, while the others didn’t know.

However, 47% of the average-risk women received no recommendation either way about removal of the healthy breast. Among these women, 19% decided to undergo a double mastectomy.

Nearly all who chose to have the unaffected breast removed cited peace of mind as the primary reason, the researchers found.

The study results were published Dec. 21 online in JAMA Surgery.

My Take:
Angelina Jolie does have the BRCA gene mutation and is at high risk for recurrent breast cancer. However, it is unfortunate that so much misinformation accompanied her public announcement.

Iatrogenic disease is defined as a disease caused by the words or actions of a doctor. In this situation, the iatrogenic disease is caused by the lack of words from the doctor. The term “doctor” means teacher. All physicians have an obligation to inform their patients as to pros and cons of any treatment.

The Bottom Line:
If you doctor will not weigh in on the risks/benefits of bilateral mastectomy, then you must do the research. This article is a good start.

Source: December 21 2016 National Institute of Health

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