Breast removal more prevalent

Many women choose double mastectomies even when guidelines don't call for them

October 23, 2007|By Thomas H. Maugh II | Thomas H. Maugh II,LOS ANGELES TIMES

The number of women having both breasts removed after a tumor is found in one increased 150 percent during a five-year period despite a lack of evidence that double mastectomies increase survival in most women, researchers reported yesterday.

Guidelines for treatment of a localized breast cancer call for removal of the tumor and not for a mastectomy, let alone a double mastectomy.

But an increasing number of women, particularly young, white women, are pushing for the more aggressive procedure for reasons that are not totally clear, the researchers said.

The researchers surmised that some women think that their tumors were not detected early enough and that continued screening would not be effective. Others, they surmise, might have been traumatized by chemotherapy. Another factor might be that improvements in reconstructive surgery have made double mastectomies more acceptable.

"If they are making this decision based on fear, and thinking that it will increase their survival, then that would concern me," said Dr. Julie Gralow of the University of Washington, a spokeswoman for the American Society of Clinical Oncology.

"But if they understand that it won't necessarily improve their survival, and that emotionally it is the best thing for them, then we would have to support it," said Gralow, who was not involved in the study.

Dr. Benjamin Paz of the City of Hope Comprehensive Cancer Center in California called the trend "alarming, because the goal of medicine is to help people live well with their organs."

Paz, who was not involved in the study, attributed the trend in large part to the increasing use of magnetic resonance imaging, which reveals many small lesions in breasts that couldn't be observed before.

"A woman goes through this, and she feels that [the cancer] is spreading all over," he said. "It is very difficult to explain to such a woman that she can be treated with breast conservation."

An estimated 178,480 women will receive breast cancer diagnoses this year, according to the American Cancer Society, and about 40,460 will die of the disease.

Dr. Todd M. Tuttle of the University of Minnesota Medical School and his colleagues conducted the study because they had noticed the number of double mastectomies rising but could find no data on the subject.

Using a federal cancer registry, which included information from 16 regions accounting for about 26 percent of the nation's population, they identified 152,755 patients with cancer in one breast from 1998 to 2003.

They reported in the Journal of Clinical Oncology that during that five-year period, 57.8 percent of women who were operated on underwent breast-conserving surgery, also known as a lumpectomy, and 38.9 percent had a unilateral mastectomy.

Overall, the rate of double mastectomies rose from 1.8 percent in 1998 to 4.5 percent in 2003, the latest year for which data are available. Among women having mastectomies, the proportion having the second breast removed prophylactically rose from 4.2 percent in 1998 to 11 percent in 2003.

Thomas H. Maugh II writes for the Los Angeles Times.

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