Breast Cancer: Trend Towards Double-Mastectomy

9. May 2017
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Increasingly often, doctors receive requests for prophylactic mastectomies from patients with breast carcinoma. From a scientific perspective, the affected individuals rarely benefit from the procedure. What role do role models in the media play?

Breast cancer remains one of the most common causes of death. Rebecca Nash, scientist at Emory University in Atlanta, Georgia, now reports dangerous trends: In the US, patients are increasingly choosing to have contralateral prophylactic mastectomies.

Precautionary removal

As part of a cohort study Nash compiled data from more than 1.2 million women with locally invasive cancer in one breast. Medical records came from all US states between 2004 and 2012.

A glance at the age group aged 45 years and over reveals that at the beginning of the study period surgeons removed the second breast of 4,133 out of 113,001 women (3.6%) by choice. In 2012 this figure was 12,890 out of 124,231 (10.4 percent).

Even more pronounced was the result relating to women between 20 and 44. Whereas in 2004 1,879 out of 17,862 people (10.5 percent) chose this intervention, in 2012 precisely 5,237 out of 15,745 (33.3 percent) decided to take this option.

In her evaluation, Nash reports several peculiarities. On the one hand, the number of breast cancer diagnoses did not correlate with the prevalence of precautionary mastectomies. According to data from the National Cancer Institute there has been no significant change in trend in figures on newly diagnosed cases. Mortality has even been declining. In contrast, the number of operations was clearly rising.

An explanation: the outing by famous people

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Professor Dr. Rita Schmutzler © Wikipedia

Professor Dr. Rita Schmutzler, director of the Center for Familial Breast and Ovarian Cancer at the University Hospital of Cologne (Germany), is not surprised by the study. She informs us about similar developments based on the Californian cancer registry. “This increase is accompanied by a growing awareness of possible genetic risk factors for breast cancer, driven by revelations from famous people such as Angelina Jolie”, says Schmutzler. Due to mutations detected in the BRCA1 gene, the actress underwent a bilateral prophylactic mastectomy and later an ovarectomy.

Genes such as BRCA1 and BRCA2 enhance the risk of malignant diseases in the supposedly healthy breast. In cases involving such women, “a contralateral mammary gland removal should be considered, taking into account the prognosis of the primary carcinoma”, the expert adds. Human geneticists deduce that only five to ten percent of all cases relate to high-risk genes. They indicate multifactorial causes, such as spontaneous mutations, infections, environmental influences or irradiation, far more often.

Perhaps scientists have not found anything yet?

Laypersons have not yet arrived at this understanding, as a glance in different patient forums shows. Many women assume that secondary-disease risks in BRCA1 /BRCA2 negative families are similarly high. DocCheck has checked out numerous patient forums. One patient writes: “Perhaps scientists have just not found anything yet”. She makes mention of several cases among her relatives. And another writes: “For me, Angelina Jolie is the role model. She got the task done”.

Schmutzler relativises this with reference to epidemiological data. It was shown here that BRCA1/ BRCA2 negative women with breast cancer in the family have a significantly lower risk of developing contralateral secondary carcinoma than do carriers of the BRCA1/ BRCA2 mutation. “The vast number of recently identified risk genes and risk loci carry a small to moderately increased risk”, the specialist adds.

Subjective factors

Sarah T. Hawley from the Ann Arbor Healthcare System also addressed the question as to why women opt for a contralateral prophylactic mastectomy. Together with colleagues, she questioned 1,447 breast cancer patients. Every fifth study participant (18.9 per cent) had considered undergoing the intervention, and with 7.6 percent precautionary removal of a breast was carried out.

Associated factors mentioned by the lead author for making this decision include patient anxiety, similar illness in the family (irrespective of genotype) and a high level of education. Medical diagnostics, especially MRIs and genetic testing, were also associated with these interventions – regardless of their outcome, it’s worth bearing in mind.

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Image copyright: Kana Natsuno, flickr / Licence: CC BY-SA
Gynaecology, Medicine, Surgery

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