Many of todayâ€™s newspapers, including the New York Times and the San Jose Mercury Newscarried stories about a study published in the online issue of the Journal of Clinical Oncology that found that a small but growing number of women are choosing to have their healthy breast removed at the same time they have their cancerous breast removedâ€”even though having this surgery will not improve their survival.
As I travel around the country, I have met women who have made the decision to have a double mastectomy as well as women with friends who have chosen this course of action. Some of the women I have met, like those quoted in these stories, say they knew a double mastectomy wouldnâ€™t help them live longer, but that they did it anyway because they felt that, at some level, they would know they did everything possible.
I certainly understand and empathize with a womanâ€™s decision to be aggressive in her treatment. But I fear that part of the reason for this increase in double mastectomies is because surgeons are not explaining to women that:
1.There is a 5-10% recurrence rate in the scar with a mastectomy, which is comparable to the 5-10% local recurrence rate with lumpectomy.
2. What you do locally does not impact survival.
3. That the risk of a woman getting cancer in the other breast is not that high and is often lower than the risk of recurrence of the cancer.
Another contributing factor: Itâ€™s easier to do surgery and reconstruction when a woman has a bilateral mastectomy, and the reimbursement rate is higher, too. So, I think our health care system is contributing to the problem.
I was reminded yet again of the role our health care system plays in womenâ€™s decision-making at last yearâ€™s San Antonio Breast Cancer Symposium when a research team reported that we do more mastectomies in the