Physicians’ Misunderstanding of Genetic Test Results May Hamper Mastectomy Decisions

Excerpt:

“A recent survey of over 2,000 women newly diagnosed with breast cancer found that half of those who undergo bilateral mastectomy after genetic testing don’t actually have mutations known to confer increased risk of additional cancers, according to a study by researchers at the Stanford University School of Medicine and four other U.S. medical centers.

“Instead the women had what are known as variants of uncertain significance, or VUS, that are often eventually found to be harmless. A bilateral mastectomy is a surgical procedure in which both of a woman’s breasts are removed after a diagnosis of in one breast.”

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Super Patient: Honesty and Openness Help Lori Through the Holidays


When it comes to the holiday season, Lori Wallace, a mother of two sons, is accustomed to being in charge. “I’m the mom, I’m kind of the epicenter of my family,” she says. “So I make Christmas.”

But in early April of 2011, Lori woke up with pain in her breast from what she thought was a small toy left in her bed by her five-year-old. No toy was there, and the pain persisted. She soon had her diagnosis: stage IIA invasive ductal carcinoma. Continue reading…


Video: Dr. Ann Partridge on Epidemic of Bilateral Mastectomies in Breast Cancer

“Ann Partridge, MD, MPH, breast medical oncologist, Dana-Farber Cancer Institute, discusses optimal local therapy for women with breast cancer. Partridge says that while studies have shown that lumpectomy followed by radiation is the equivalent of having a mastectomy, there continues to be a growing epidemic of women getting a bilateral mastectomy for unilateral breast cancer. These surgeries include women who are not at high-risk.

“Partridge says these bilateral mastectomies should be better explained to women who opt to have them. She adds that the common misconception is that once both breasts are removed, a patient is cancer free and “the hard part” is over. Partridge says the complications for women who opt to reconstruct their breasts after a bilateral mastectomy still poses significant health risks.”

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Sharp Rise in Mastectomy in Early-Stage Breast Cancer

The gist: Despite breast conservation surgery (lumpectomy) becoming “a standard of excellence” for breast cancer, more and more women with early-stage breast cancer are opting for more invasive surgeries like mastectomy, bilateral mastectomy, and breast reconstruction. This trend sticks out because many other kinds of surgery have become less invasive. Lumpectomy and mastectomy give the same survival outcomes for most women with early-stage breast cancer.

“A retrospective cohort study of more than 1.2 million women treated for early-stage breast cancer in the United States has confirmed rising trends in the proportion of patients who undergo mastectomy, bilateral mastectomy, and breast reconstruction rather than breast conservation surgery for which they are eligible. Findings were reported in JAMA Surgery by Kristy L. Kummerow, MD, of the division of surgical oncology and endocrine surgery, and colleagues at the Vanderbilt University Medical Center and Tennessee Valley Healthcare System, Nashville, Tennessee.

“Breast conservation surgery was endorsed by the National Institutes of Health Consensus Conference in 1990 after studies demonstrated equivalent outcomes with mastectomy in early-stage breast cancer, ‘and has become a standard of excellence in breast cancer care,’ noted the authors. Accredited breast centers in the United States are thus measured on performance of breast conservation surgery in more than 50% of women who are eligible.

“All participants in the study were treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer from January 1, 1998, to December 31, 2011, using the National Cancer Data Base. The study was designed to determine the proportion of women with early-stage breast cancer who underwent mastectomy. Secondary outcome measures included temporal trends in breast reconstruction and bilateral mastectomy for unilateral disease.”


Double Mastectomies Don't Yield Expected Results, Study Finds

“More women are choosing to have bilateral mastectomies when they are diagnosed with early-stage breast cancer, even though there’s little evidence that removing both breasts improves their survival compared with more conservative treatments.

“The biggest study yet on the question has found no survival benefit with bilateral mastectomy compared with breast-conserving surgery with radiation.

“The study, published Tuesday in JAMA, the journal of the American Medical Association, looked at the records of all women in California who were diagnosed with early-stage breast cancer from 1998 to 2011 — 189,734 women, all told.

“Women who had breast-conserving surgery had an 83.2 percent survival rate at 10 years, compared with 81.2 percent for those who had a double mastectomy. That meant that women who had breast-conserving surgery, also known as lumpectomy, did better and also avoided the risks of major surgery and loss of a healthy breast.

“The study also looked at women who had a single mastectomy, which was the least popular option. They fared worse, with a 79.9 percent survival rate, enough to be statistically significant.”