Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies Don’t Yield Expected Results, Study Finds.”
This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an equal survival benefit for properly selected patients. This finding has been confirmed and reconfirmed by randomized clinical studies conducted in the U.S. and internationally. This most recent study was the largest yet on this topic, but it only confirmed what physicians already know.
The study’s findings aren’t news to breast cancer patients, either. Responsible doctors inform their patients that a mastectomy or double mastectomy does not offer a survival benefit compared to a lumpectomy combined with breast radiation. It would be malpractice to tell them otherwise. The only exceptions are tumors that cannot be successfully removed with lumpectomy, and perhaps those associated with BRCA gene mutations. (Most doctors recommend mastectomy for young patients with a BRCA gene mutation to reduce the high risk of a second, new, unrelated breast cancer, but preventative mastectomy has not yet been formally proven to decrease mortality.)
So, why the headlines? Because most people who are not doctors or breast cancer patients do not know this fact — and thus think that something amazing has been discovered.
The truth is that the nuances behind this story don’t fit into a headline. Women choose mastectomies for many valid reasons other than survival.
One reason is to minimize the chance of a second breast cancer. (This occurrence is completely different from a life-threatening return of the first cancer, which is no less likely with mastectomy or breast conservation). A 30-year-old woman has about a 30 percent chance of having a second, unrelated breast cancer detected in her lifetime. The second cancer doesn’t change her chance of survival, as it usually is found at an earlier stage than the first. If the first cancer was cured, the second will most likely be cured. But that woman may choose a double mastectomy (usually with immediate reconstruction) to avoid a second round of treatment.
Another reason some women choose a mastectomy over a lumpectomy is their appearance. Modern, immediate reconstruction techniques often preserve the nipple and skin. Some women are happier with their final cosmetic appearance than they were before surgery, though there are downsides, including loss of sensation and more extensive surgery.
A third reason is stress. Some women report that ordinary breast cancer screening mammograms are just too stressful for them after breast cancer treatment.
Meanwhile, other women choose lumpectomies to avoid additional surgery, or because they would like to preserve their breasts.
The takeaway here is that we are finally at a point in the fight against breast cancer where many women have treatment options. It is time to respect well-informed women’s decisions about what is best for them without sensationalizing, questioning or diminishing their choices.
A woman has as much right to choose a lumpectomy as a mastectomy or double mastectomy, and vice versa. And — without a survival benefit in play — she deserves to have her preference respected, not her arm twisted.
Pat Whitworth is a clinical researcher and breast surgeon at Centers for Breast Health, Saint Thomas Health, Nashville, TN,
