“Vivien Foldes says she does not regret having her breasts removed five years ago after she was found to have an early-stage cancer.
“But there are things Ms. Foldes, a 58-year-old accountant from Woodmere, N.Y., wishes she had known when she chose a double mastectomy, like the fact that the process of reconstruction would drag on for five months and leave her forever unable to sleep on her stomach. Or that it would leave her with no sensation ‘from the front all the way to the back in the entire bra area,’ she said. ‘Nothing. Zero. Zip.’
“Ms. Foldes says there are days that she asks herself, ‘Should I have done it?’ But, she said, her mother had two types of cancer, and she wanted to be proactive: ‘I didn’t want to be waiting for the other shoe to drop.'”
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“For years, doctors and researchers have been concerned about a surprising trend: More and more women with early-stage cancer in one breast were choosing to have double mastectomies to reduce the risk of cancer in the other.
“Many of the patients said they thought an aggressive approach would help their quality of life by lessening their worries about future cancer and making them more comfortable with their bodies.
“But new evidence released Monday shows that the surgery doesn’t improve peace of mind or quality of life very much.”
“The public’s awareness of reconstructive breast surgery options were boosted following media coverage of Angelina Jolie’s hereditary disposition to breast cancer and preventive double mastectomy in 2013. The results of a prospective, public survey were published earlier this week in Cancer.
“Significantly more women were aware of reconstructive breast surgery options after mastectomies for breast cancer. About 20% of the 205 women polled communicated that their awareness and interest in breast cancer stemmed from the media coverage of Angelina Jolie. The survey results suggest that media coverage can improve the health IQ of the public.
“ ‘The results underscore the importance of a media-related impact for professionals in the health care sector, which can serve as a tipping point for raising awareness and improving knowledge concerning a specific disease among the general public,’ wrote David Benjamin Lumenta, MD, of the department of surgery at the Medical University of Graz in Austria, and colleagues.”
“The rate of double mastectomy among men with breast cancer increased significantly between 2004 and 2011, reveals a new study published in JAMA Surgery.
“According to the American Cancer Society, many people are unaware men can develop breast cancer, but they account for 1% of all breast cancer cases in the US.
“While breast cancer in men is around 100 times less common than in women, a 2012 study from The American Society of Breast Surgeons found men are less likely than women to survive the disease.
“Among women with invasive breast cancer in one breast, there has been a significant increase in double mastectomy – the surgical removal of both the cancerous and unaffected breast – rising from 2.2% in 1998 to 11% in 2011.”
“As many as 60,000 American women each year are told they have a very early stage of breast cancer — Stage 0, as it is commonly known — a possible precursor to what could be a deadly tumor. And almost every one of the women has either a lumpectomy or a mastectomy, and often a double mastectomy, removing a healthy breast as well.
“Yet it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying of breast cancer as women in the general population, and the few who died did so despite treatment, not for lack of it, researchers reported Thursday in JAMA Oncology.
“Their conclusions were based on the most extensive collection of data ever analyzed on the condition, known as ductal carcinoma in situ, or D.C.I.S.: 100,000 women followed for 20 years. The findings are likely to fan debate about whether tens of thousands of patients are undergoing unnecessary and sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.”
“A survey of women with breast cancer found that nearly half considered having a double mastectomy. But of those who considered it, only 37 percent knew that the more aggressive procedure does not improve survival for women with breast cancer.
“Among women who received a double mastectomy, 36 percent believed it would improve their survival. Studies have shown that for women at average risk of a second cancer, removing the unaffected breast does not meaningfully improve survival.
“The study, which was presented at the American Society of Clinical Oncology annual meeting, looked at 1,949 women who had been treated for breast cancer. About 20 percent of the women surveyed had both breasts removed, a procedure called contralateral prophylactic mastectomy. Even among patients without a genetic mutation or family history that might put them at risk of developing cancer in the other breast, 19 percent had double mastectomy.”
“Nearly 25 years ago, the National Cancer Institute declared that women with early-stage breast cancer could be spared mastectomies. The institute acted after studies found that breast removal offered no survival benefits over removing just the lump and following up with radiation treatments.
“This caused the pendulum to swing hard away from mastectomies, from a rate of nearly 100 percent in the 1980s for patients with small tumors that had not spread beyond the breast or surrounding lymph nodes to less than 40 percent today.
“Now, though, the pendulum is starting to swing back in a surprising way.
“Breast surgeons have recently seen a surge in patients with small nonaggressive tumors who opt to have one or both breasts removed (including the one that’s cancer-free) rather than removing just the malignant lump in one, called a lumpectomy.”
“When Angeline Vuong, 27,was diagnosed with cancer in one breast earlier this year, her first reaction was ‘A DOUBLE MASTECTOMY. NOW. ‘ Turns out, she’s far from alone: a recent JAMA study of 190,000 breast cancer cases in California between 1998 and 2011 found a six-fold increase in the percentage of women with early-stage cancer in one breast who were choosing double mastectomies.
“But are they necessary? And do they reduce your risk of a second cancer?
“The answers to these and other questions regarding double mastectomies may surprise you: if you have breast cancer in one breast, removing your other breast will not increase your chances of survival. It won’t help you live longer, and it doesn’t decrease a woman’s chance of metastatic disease, when the cancer spreads from the breast to the lymph nodes, lungs or bones.
“Dr. Deanna Attai, UCLA Health breast surgeon and Angeline’s doctor, says every patient is different, and that ultimately the choice to get a double mastectomy is complex and up to patients, their families and their doctors. But most women don’t know the facts about double mastectomy risks – and they should be aware of them before making a decision.”
“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.”