A recent study has found that for women diagnosed with breast cancer, opting for a double mastectomy may not provide a survival advantage compared to those who choose less extensive surgery. Dr. Steven Narod and colleagues from Women’s College Hospital in Toronto analyzed data from over 661,000 American women with breast cancer in one breast and reported their findings in JAMA Oncology.
The study revealed that women who underwent lumpectomy or mastectomy on one side and retained their other breast had similar survival outcomes as those who opted for a double mastectomy. Despite concerns about the cancer potentially recurring in the opposite breast, the researchers found that the risk of this occurring over a 20-year period was approximately 7%.
However, the study’s conclusions may not apply universally, particularly to women with the BRCA1 or BRCA2 gene variants, which significantly elevate their risk of breast cancer. For these women, medical experts agree that considering a double mastectomy might be beneficial due to their heightened susceptibility to developing breast cancer.
Dr. Narod acknowledged that the finding that a double mastectomy does not improve survival outcomes for many breast cancer cases is surprising. This sentiment was echoed in an accompanying editorial by Dr. Seema Ahsan Khan and Masha Kocherginsky from Northwestern University, who described the study’s results as a paradox.
Dr. Eric Winer from Yale Cancer Center emphasized that the study, consistent with previous research, indicates that survival rates are comparable regardless of whether a woman chooses lumpectomy, mastectomy, or double mastectomy. Dr. Angela DeMichele from the University of Pennsylvania highlighted the rigorous nature of the analysis, underscoring that the risk of developing cancer in the opposite breast was consistently around 7%, irrespective of the initial cancer’s stage.
Despite the lower risk of a second cancer in the remaining breast after a double mastectomy, Dr. Narod noted that mortality risk still increased in those who did develop such cancers, pointing out a perplexing aspect of the research. He concluded that the primary cause of death in these cases is typically the spread of the initial cancer to other parts of the body, rather than the development of a second breast cancer.
Dr. DeMichele emphasized to patients the importance of understanding that the extent of surgery does not necessarily correlate with improved outcomes. She explained that treatments like chemotherapy and hormonal therapies play a crucial role in preventing cancer cell spread, regardless of whether a woman opts for a double mastectomy.
Dr. Khan advised that while a double mastectomy is not a definitive solution, some women may choose it to alleviate the anxiety of ongoing screenings or the prospect of undergoing cancer treatment again in the future. Additionally, aesthetic considerations and personal preferences may influence decisions regarding surgery.
In conclusion, the study provides important insights for women facing decisions about breast cancer treatment, emphasizing the complexity of balancing medical considerations with individual preferences and psychological factors.
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