Posted: March 3, 2016

Wong and colleagues from the Harvard School of Public Health have done the medical community and the public a great service by publishing a huge study in the  Annals of Surgery (see link for the abstract; Dr. Stark can email you the full article) showing a large percentage increase in the number of women with newly diagnosed breast cancer who opt to undergo prophylactic contralateral mastectomy.  This approach has skyrocketed in the last fifteen years with a quadrupling of women who elect to undergo this procedure.  The authors find a variety of reasons why this might be so, but improved outcome is not one of them.  They believe that this approach is an emotional reaction to the diagnosis, with women wanting simply to be rid of the risk of contralateral breast cancer and not having to worry about future screenings.  The percentage of women who undergo bilateral mastectomy who then have simultaneous reconstruction is also way up, suggesting that the desire to achieve the optimal cosmetic result (it’s easier to achieve symmetry when both breasts are removed) may be playing a role.  Based on their review of the literature the authors believe that the notion among women that having the other breast removed will increase their chances of survival — even though this idea is without scientific merit.  In fact, when they reviewed the survival difference between women who had the other breast removed and those that did not, there was absolutely none.  What role the popular press and women’s advocacy groups play in this decision process is not addressed by the authors, but it may be substantial.  Dr. Stark comments, “These data show a triumph of emotion over data.  I wouldn’t presume to put myself in the place of women with newly diagnosed breast cancer, but perhaps surgeons and oncologists could do a better job of educating patients in the lack of benefit associated with contralateral mastectomy.  Women followed for breast cancer have frequent imaging studies of the contralateral breast, and the vast majority of tumors found in them are small and non-lethal.”