University of Virginia Health System

Double Mastectomy for Breast Cancer Prevention on the Rise

Women diagnosed as having breast cancer who have a mastectomy are increasingly choosing to have their other, healthy breast removed as a preventive measure.

The rate of the procedure, called a contralateral prophylactic mastectomy, more than doubled from 1998 to 2003, says a study reported in the Journal of Clinical Oncology.

Study lead author Dr. Todd Tuttle of the University of Minnesota Medical School is concerned that many women may be making the choice for inappropriate reasons, and that removing the other breast may be unnecessary.

"We don't know why women are choosing this," says Tuttle. "If they are choosing it because they think it will improve their breast cancer survival, I am very concerned. It won't improve their overall survival."

Research has failed to show improved survival rates with the second mastectomy, says Tuttle. The reason: the risk of cancer spreading from the original breast to other body sites often exceeds the risk of getting cancer in the second breast, he says.

David Brenin, M.D., Chief of Breast Surgical Services at the University of Virginia Health System, says he was very surprised by the report's findings.

Brenin says he almost never recommends a contralateral prophylactic mastectomy to his patients.

"In general, we recommend that women delay any decision regarding prophylactic surgery until after their cancer is treated. We feel that allowing time to pass between the diagnoses of cancer and making a decision regarding the removal of the, healthy, unaffected breast results in a more carefully reasoned plan," Brenin says. "It is too easy to make a poor decision during the very stressful time immediately surrounding the diagnosis of cancer - a decision that one may end up regretting years later."

Caucasian, Young Women Select Most

Tuttle and his colleagues evaluated 4,969 women who chose contralateral prophylactic mastectomy through a national database called Surveillance, Epidemiology and End Results (SEER).

From 1998 to 2003, the rate of preventive mastectomy for the second, healthy breast increased from 4.2 percent to 11 percent. Those most likely to choose the preventive operation were younger women and non-Hispanic Caucasians.

Tuttle says there are times when a second mastectomy is appropriate.

"I will tell patients to consider it strongly if they have a known genetic mutation - BRCA1 or BRCA2 [the so-called breast cancer genes] - or a very strong family history, such as first-degree relatives who develop breast cancer before age 50," he says.

"Sometimes, we will recommend it in those who need mastectomy on one side and because of body symmetry issues, the other breast would be too big" once the cancerous breast is removed, adds Tuttle.

His advice is in line with advice from the Society of Surgical Oncology and the American Cancer Society. Many women overestimate their risk of getting cancer in the second breast, according to the Society of Surgical Oncology.

In addition to patients with a genetic mutation, UVA's Brenin says it would also be reasonable to perform a contralateral prophylactic mastectomy for women with other factors that would increase their chances of getting a second cancer, such as a very strong family history of breast cancer or a history of radiation exposure.

However, a study in March led by researchers at Wake Forest University found that most women diagnosed with breast cancer who also chose to have their unaffected breast removed said they did not regret their decision.

And they said their quality of life equaled that of women who chose not to have a preventive mastectomy, according to the study in the Journal of Clinical Oncology.

Dr. S. Eva Singletary of M.D. Anderson Cancer Center says the increase in requests for the preventive mastectomies found in the new study "rings true clinically" for her patient population.

Singletary credits the increase in second mastectomies to "an improvement in breast reconstruction techniques," among other factors.

Women who opt for immediate reconstruction after a mastectomy may be more likely to choose contralateral mastectomy and get the second breast reconstructed at the same time, she says. Women will sometimes choose to have both breasts reconstructed to achieve better symmetry, particularly if they are heavy, she says.

To read a patient story, get additional information on breast cancer treatment or learn about UVA's Breast Care Program, visit www.uvahealth.com. 

UVA also offers a free, confidential risk assesment through the region's only High Risk Care program to determine if you have a higher-than-normal personal risk of developing breast or ovarian cancer. This free service is particularly encouraged for women with a strong family history of breast or ovarian cancer. To arrange the free screening, call 434-982-0808.

Women can learn more about their unique risks for heart disease - and how to better manage those risks - through Live Red, a new UVA heart-health initiative. You'll learn how heart attack symptoms can be different for women than for men, and you can take an online risk assessment to learn your personal heart disease risk factors.

There, you can sign up for Club Red, our free heart-healthy club for women. Benefits include tips from UVA healthcare providers and a gift package to help you live red in style.

Always consult your physician for more information.