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Radical Surgery For Breast Cancer Raises Concerns

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By THOMAS H. MAUGH II, Los Angeles Times

Published: October 23, 2007

The number of women having both breasts removed after a tumor is found in one increased by 150 percent over a five-year period, despite a lack of evidence showing that double mastectomies increase survival in most women, researchers reported Monday.

Young women are most likely to choose the aggressive operation, researchers report in the Journal of Clinical Oncology.

The concern is whether they're choosing in the heat of the moment - breast cancer surgery often is within two weeks of diagnosis - or with good understanding of its pros and cons.

'Are these realistic decisions or not?' asks Todd Tuttle, cancer surgery chief at the University of Minnesota, who led the study after more women sought the option in his hospital.

'I'm afraid that women believe having their opposite breast removed is somehow going to improve their breast cancer survival. In fact, it probably will not affect their survival,' he said.

The initial tumor already may have sent out seeds to spread to key organs, Tuttle said.

But removing the remaining healthy breast does greatly lower, although not eliminate, chances of a new cancer developing on the opposite side.

Don't underestimate the peace of mind that brings, said Trisha Stotler Meyer of Vienna, Va., who had her breasts removed three weeks ago.

'Doctors are not up at night crying' in fear of their next mammogram, said Meyer, 37, who went back for a double mastectomy after her initial cancer surgery. 'I don't want to have to deal with the stress.'

Current guidelines for treatment of a localized breast cancer call only for removal of the tumor and not for a mastectomy - much less a double mastectomy.

But an increasing number of women, particularly young white women, are pushing for the more aggressive procedure for reasons that are not totally clear, researchers said.

They surmised that some women think the health care system did not detect their tumor early enough and that continued screening would not be effective, while others might have been traumatized by chemotherapy.

Improvements in reconstructive surgery also have made a double mastectomy a more acceptable alternative.

'If they are making this decision based on fear, and thinking that it will increase their survival, then that would concern me,' said Julie Gralow of the University of Washington, a spokeswoman for the American Society of Clinical Oncology.

'But if they understand that it won't necessarily improve their survival, and that emotionally it is the best thing for them, then we would have to support it,' said Gralow, who was not involved in the study.

An estimated 178,480 women will be diagnosed with breast cancer this year, according to the American Cancer Society, and about 40,460 will die of it.

Tuttle and his colleagues used data from the federal government's Surveillance, Epidemiology and End Results cancer registry, which included information from 16 regions that represent about 26 percent of the country. They identified 152,755 patients with cancer in a single breast from 1998 to 2003.

They reported that, over the five-year period, 57.8 percent of women who received surgery underwent breast-conserving surgery, also known as a lumpectomy, and 38.9 percent had a unilateral mastectomy.

Overall, the rate of double mastectomies rose from 1.8 percent in 1998 to 4.5 percent in 2003, the latest period for which data is available.

Among women having a mastectomy, the proportion having the second breast removed as a prophylactic rose from 4.2 percent in 1998 to 11 percent in 2003.

And the trend shows no signs of slowing down.

'Some women are so traumatized by having a breast cancer, especially if it is not found early, that they have a lack of trust in the whole system of finding the next one early,' said Christy A. Russell of the University of Southern California's Keck School of Medicine, who was not involved in the study. 'It seems easier to remove everything and not have to deal with mammography screening any more.'

Information from The Associated Press was used in this report.

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