Breast Ca: Mastectomies

  In an early release of the Journal of Clinical Oncology on-line dated Oct. 22, 2007 is a report on a study conducted at the University of Minnesota on the increase of patients choosing to have a mastectomy performed on the opposite unaffected breast in order to prevent cancer in the future. For women diagnosed with Breast Cancer, it has always been an option to have the entire breast surgically removed. As more and more data has been collected, and more in depth studies have been conducted, there has been a trend for more women to choose to have Breast Conserving Surgery versus the entire removal of the Breast affected with cancer. However, this study conducted at the University of Minnesota has seen a gradual yet significant increase. In 1998 there was about 1.8% of all breast cancer patients decided to have both breasts removed. As of 2003, the data collected at the University of Minnesota has shown an increase to 4.5% of all patients.
  The study analyzed data from a small fraction of the estimated 200,000 women who receive a breast cancer diagnosis each year in the U.S. If these figures are accurate, it could be seen that there is an average of 8000 to 10,000 women a  year choosing to have this elective surgery done. The name of the surgery is called: Contra-lateral Prophylactic Mastectomy (surgical removal of opposite breast not affected with breast cancer.)
Some patients decide to have this major operation because they just want the best option for survivability. There is the thought process that I just want this thing out of my body. I want to do everything in my power to give me the best opportunity to defeat this cancer from ever coming back in the future. By removing both breasts, some patients feel that this is the best choice for them.
The studies lead author, Dr. Todd M. Tuttle, chief of surgical oncology at the University of Minnesota started the study because so many of his patients were requesting to have the procedure performed. Dr. Tuttle said that he was surprised that so many patients were deciding to have the unaffected breast removed as well. He noticed the trend was moving upwards and that it shows no signs of leveling off, even as breast conserving surgery (lumpectomy) expands and becomes more popular.
He stated that some of his patients have said that they just want to be done with it. They do not want to have to think about breast cancer ever again, or to have to deal with having another mammogram performed, or to go through another biopsy, then the waiting of finding out if it is back or if it isn’t.
The thing that is VERY important for patients to realize is that even thought the breast is removed, and that the risk of recurrence is drastically reduced, it does not mean that the risk is zero. This is because there is still some breast tissue that remains behind. Surgeons are good, but there is no way that they can ensure that every single piece of breast tissue has been removed from the patient. Another thing to remember is that its the initial cancer diagnosis that poses the greatest threat to a patient’s life.
The study used data from cancer surveillance registries covering about a quarter of the United States to identify 152,755 patients whose cancer was diagnosed in one breast from 1998 to 2003. The rate rose steadily, with 4.5 percent of all patients who received breast cancer diagnoses in 2003 having the surgery, up from 1.8 percent in 1998.
In those patients that chose to have a mastectomy for the breast that was found to have cancer, 11% (2003) decided to have the other breast removed for prevention of future breast cancer as well. This was up from 4.2% in 1998. Patients with stage I breast cancer choose to have the procedure done more often then those patients with more advanced and aggressive breast cancer.
Younger women, white women and women with a previous cancer diagnosis were more likely to opt for a contra-lateral prophylactic mastectomy, the study found, as were women who had lobular histology, meaning the cancer started in the lobules or milk-making glands of the breast.
What the researchers are also noticing is that there are two extremes being seen by patients with Breast Cancer. One group decides to have lumpectomy, or a minimal surgery, and the other group decided to have a both breasts removed. There are fewer women deciding to just have one breast removed.
  The most important thing for all of us to remember is that education is the best tool for all of our patients, family members, and loved ones. In order for patients to make the best decision for themselves, we need to arm them with all of the facts surrounding their disease and diagnosis. Before any patient makes a decision to have surgery, they should also meet with a Radiation Oncologist as well as a Medical Oncologist to know all of their treatment options up front. This allows a patient to have all of the information in front of them in order to make the best decision based on their cancer type, life style, and personal needs. A patient may decide that having a lumpectomy and radiation followed by Tamoxifen or Femara is a far better choice for them physically, emotionally, and personally versus having both breasts removed.
If you as a patient feel that you are not armed with all of the information prior to making a decision, remember that you have every right to tell the physicians to slow down, that you want a second opinion, and that you want to meet with the entire team of physicians in order to make the best informed decision around the type of cancer you have.
As always, if you or a loved one have any other questions, comments, or concerns; if you would like more information in regards to another cancer related topic, please contact me at: CANCERGEEK@GMAIL.COM or CANCERGEEK@CANCERGEEK.COM

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