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When a woman receives a diagnosis of breast cancer, her
treatment options will depend on a number of factors. For early stage cancer,
meaning stage I or II, doctors often recommend surgical removal of the tumor
and tissue surrounding it (lumpectomy), followed by radiation.
Today, though that is still the treatment the majority of
women receive, there has been an increase in women choosing breast removal (mastectomy),
or even choosing to have both breasts removed (double mastectomy). Despite the
evidence that a lumpectomy plus radiation has similar survival rates to
mastectomy, some women are uneasy with that option. The reasons are complex,
but here’s what experts know about why double mastectomies are on the rise.
Better Breast Reconstruction Techniques
Advances in breast reconstruction may influence a woman’s
decision to have one or both breasts removed and, since 1998, your health insurance
must cover reconstruction. Some women feel they may have more symmetrical
breasts if both are removed and reconstructed, because natural breasts age
differently than reconstructed breasts. However, a double mastectomy is a
bigger operation than a single mastectomy or lumpectomy, meaning recovery time
is longer and there is a greater risk of complication.
Peace of Mind
For some women, anxiety over a recurrence of cancer may
outweigh the desire to keep a breast. The comfort of greatly reducing the
chance of having another tumor can be a factor in making the decision to opt
for a double mastectomy. Still, survival rates are very similar between women
who choose to keep the healthy breast and those who have a mastectomy. Talk to
your doctor about your individual situation, because your genetic makeup and
family history play a role in the likelihood of having further cancer.
Shared Decision-Making Between Doctor and Patient
Today, patients tend to play a bigger role in treatment
decisions than in the past. While many doctors recommend breast-conserving
surgery such as a lumpectomy, women may choose on their own to have one or both
breasts removed and ask their doctors to perform the surgery. The choice to
have a single or double mastectomy rather than a lumpectomy is more common among
younger, more educated women, especially those under 40.
Overestimating Chances of Cancer in the Other Breast
Research shows both patients and doctors may feel there is a
greater risk of getting cancer in a remaining breast than statistics indicate.
Women with early stage breast cancer who don’t have certain genetic mutations
or a strong family history of the disease have a less than 1% chance per year
of developing more cancer. When a woman does develop cancer in a second breast,
it is a new cancer, not a recurrence. Talk to your doctor about your risk for
recurrence so you can make sure you are weighing the facts based on evidence.
The Role of the MRI
MRI scans, an imaging technique for examining organs and
tissue, create a sophisticated image that shows more detail than an X-ray or
ultrasound. Today, an increasing number of women get an MRI prior to breast cancer
surgery, which may show potentially suspicious areas. Some experts feel the
anxiety from MRI results increases the likelihood of a woman opting for a
double mastectomy. However, MRIs have a high rate of false positives, which
means something that may look questionable is actually harmless. If you have
concerns about the results from an MRI, talk to your healthcare provider about
them before you make any decisions.
If you have been diagnosed with breast cancer:
-
Make sure you understand
your treatment options and discuss them thoroughly with your doctor. -
Don’t be afraid to get a
second opinion and ask how much time you can take before deciding on
treatment. -
Ask about treatment that
can lower the risk of developing further cancer. -
Ask your doctor about what
you read and hear in the media or from friends and others.
While the number of double mastectomies has risen sharply in
recent years, the survival rates for early stage breast cancer, which are over
90%, have not changed. There is no evidence to support mastectomy as increasing
the chance of survival, but by researching all of the factors involved, you can
work with your doctor to make the decision that’s right for you.