The Washington Post on Tuesday examined the increasing number of women opting to undergo preventive bilateral mastectomies after being diagnosed with the BRCA1 and BRCA2 genes, which increase the risk of breast cancer. According to a 2007 University of Minnesota study, the percentage of U.S. women with cancer in one breast who opted for a double mastectomy -- surgery to remove both breasts -- doubled over five years, from 4.2% in 1998 to 11% in 2003. The availability of tests that can identify the genes linked to some breast cancers has helped drive women's decisions to undergo the surgeries, as has the development of more sophisticated surgical options, including breast reconstruction from a woman's own tissue. However, "to remove both breasts remains a difficult and emotional decision, one that can reassure or haunt the patient for years," the Post reports. While some women at high risk of breast cancer feel that the removal of both breasts will ease future stress related to undergoing mammograms or finding lumps, others regret their decision or find that the psychological effects are stronger than they expected.
Statistics regarding breast cancer and mastectomies "can be complicated for an anxious patient to understand," according to the Post. Lillie Shockney, administrative director of the Avon Foundation Breast Center at Johns Hopkins, said a woman with a BRCA mutation but no cancer has a 65% to 80% risk of developing breast cancer in her lifetime. However, that risk declines to 5% after a preventive double mastectomy. A woman with early-stage breast cancer but no BRCA mutation has a 5% to 20% risk of local recurrence after a lumpectomy and radiation, which declines to 1% after a double mastectomy. Shockney said it is nearly impossible to remove every breast cell and that "just a few remaining cells is enough to give breast cancer a place to grow." A risk remains even after a rare "radical" mastectomy, in which the pectoral muscles and lymph nodes also are removed, the Post reports.
Todd Tuttle, the lead researcher on the University of Minnesota study, said that for women with the BRCA mutation who have had cancer in one breast, there is a 3% per year risk of developing cancer in the opposite breast. Tuttle added that the risk is cumulative, which may explain why younger women are more prone to choosing the bilateral procedure than older women. The younger women are "looking ahead to 30 or 40 more years of life, and the calculations begin to stack up against them," according to the Post. Still, "the risk of developing cancer is a separate question from whether the surgery can extend a patient's life," the Post reports. Tuttle said a woman receiving a diagnosis of breast cancer has the same chance of "survival," which is defined as living an additional five years, regardless of whether she has had a double mastectomy or a lumpectomy with radiation.
The Post reports that while less-invasive lumpectomies are still more common, the increase in the number of double mastectomies "means there are more women who have gone through bilateral surgery and can provide advice or an example to others." For example, Rep. Debbie Wasserman Schultz (D-Fla.) revealed in March that she had undergone a double mastectomy in 2008, following a December 2007 diagnosis of early-stage breast cancer and positive diagnosis for the BRCA2 mutation (Saslow, Washington Post, 4/7).
NPR Discussion With Wasserman Schultz
NPR's "Tell Me More" on Monday included a discussion with Wasserman Schultz about her decision to undergo a double mastectomy (Martin, "Tell Me More," NPR, 4/6).
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