Despite the increased use of conservation therapy for breast cancer, lumpectomy followed by radiation, a growing minority of women are electing double mastectomy instead. An article by Wong et al in the Annals of Surgery suggests that the trend is growing. They looked at thousands of women collected by the SEER database, reflecting surgical practice throughout the United States, between 1998 and 2012 and found that over that time an increasing proportion of women were electing total mastectomy on the side of their cancer, and prophylactic removal of the opposite breast at the same time. The trend was most marked in women under 55 years old, with almost 10% of women ages 45-55 electing to have the opposite breast removed, even though there was no suspicion of cancer in it. The authors speculate that the rise in incidence in this phenomenon is related to patient anxiety. Their analysis further showed, as expected, that removing the other breast had no impact on the likelihood that the woman would survive the original cancer.
Dr. Stark’s comments: It would have been useful had the authors included the incidence of testing for the BRCA 1 and 2 gene mutation in their paper. It is likely that this information was not available in the SEER database, however. BRCA testing has increased dramatically in frequency, especially among younger women. Even in women who test negative for the mutation, the mere knowledge that their is a genetic predisposition to breast cancer likely proves frightening. I saw this phenomenon in my clinical practice, and in my experience trying to talk women out of having the other healthy breast removed was a fruitless exercise. Furthermore, a couple of very busy surgeons in our community pushed bilateral mastectomy on to their patients, and it was difficult to be the bad guy in that discussion.