In a stark reversal of a long-term trend, more early-stage breast cancer patients are choosing mastectomy, despite evidence that the aggressive, disfiguring surgery has the same survival rate as removing the malignant lump, new research shows.
The study by doctors at the Mayo Clinic in Rochester, Minn., suggests that a more detailed screening technique may have led additional women to have their breasts removed.
But researchers also found a rise in mastectomies among women who weren't examined with the new magnetic resonance imaging technology. Some doctors say more women are opting to have their breasts removed because of an overwhelming fear the cancer will return.
"For some women, their quality of life is better with their breasts removed because you get rid of the concern, the anxiety" about recurrence, said Dr. Lisa Jacobs, a surgical oncologist with the Johns Hopkins Breast Center who was not affiliated with the study. "A lot of women come in and say, `I don't ever want to do this again.'"
Still, doctors worry that some patients are being treated too aggressively because many of the cancers spotted by ultra-sensitive MRI would never develop into dangerous tumors. There is also no research on whether the use of MRI improves overall survival.
The study found that 43 percent of breast cancer patients chose mastectomy at the Mayo Clinic in 2006 - up from 30 percent three years earlier. The 2006 rate was almost the same as the 45 percent of breast cancer patients who had mastectomies in 1997.
Fifty-two percent of women who had an MRI in 2006 had mastectomies, but so did 41 percent of women who didn't have an MRI.
Anecdotal evidence - and a recent study showing more breast cancer patients choosing prophylactic mastectomy in the cancer-free breast - suggests that the trend extends beyond the Mayo Clinic.
"Are we doing the right thing for women? Is converting a woman to mastectomy ... will that lead to a better clinical outcome?" said Matthew P. Goetz, assistant professor of oncology at the Mayo Clinic and one author of the study.
Goetz, who spoke to reporters yesterday, will present the paper May 31 at the American Society of Clinical Oncology's annual meeting in Chicago. The work was released yesterday along with nearly 5,000 other abstracts in advance of the conference.
