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Most Women Who Have Double Mastectomy Don’t Need It

Fear of cancer recurrence drives surgery decisions

About 70% of women who have both breasts removed following a diagnosis of breast cancer do so despite a low risk of facing cancer in the healthy breast, new research from the University of Michigan Comprehensive Cancer Center finds.

Recent studies have shown an increase in women with breast cancer choosing this more- aggressive surgery, called contralateral prophylactic mastectomy, which raises the question of potential overtreatment among these patients.

Investigators looked at 1,447 women who had been treated for breast cancer and who had not had a recurrence. They found that 8% of the women had undergone a double mastectomy, and that 18% considered having one. The results were published in JAMA Surgery.

Overall, about three-quarters of patients reported being “very worried” about their cancer recurring. Those who chose to have both breasts removed were significantly more likely to express concern about recurrence. However, a diagnosis of breast cancer in one breast does not increase the likelihood of breast cancer recurring in the other breast for most women, the authors point out.

“Women appear to be using worry over cancer recurrence to choose contralateral prophylactic mastectomy,” said lead investigator Sarah Hawley, PhD. “This does not make sense, because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast.”

The study found that among women receiving a double mastectomy, nearly 70% did not have either a family history of breast cancer or a positive genetic test. Many of these women were candidates for breast-conserving lumpectomy.

“For women who do not have a strong family history or a genetic finding, we would argue it’s probably not appropriate to get the unaffected breast removed,” Hawley said.

The study also found that women with higher education levels and women who had undergone a magnetic resonance imaging (MRI) test before surgery were more likely to choose double mastectomy. Concern about recurrence was one of the biggest factors driving the decision to have this surgery.

The researchers say that it’s important to educate women better about the risks and benefits of contralateral prophylactic mastectomy, but that surgeons must also be aware of how patients’ worries about recurrence drives their decision-making.

Sources: University of Michigan Comprehensive Cancer Center; May 21, 2014; and JAMA Surgery; May 21, 2014.

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