Dr. Shelley Hwang on choosing a double mastectomy



Double Mastectomy Doesn't Improve Breast Cancer Survival Rate, According To New Research

When faced with a breast cancer diagnosis these days, there are fortunately more treatment options than ever before. But a new study set out to determine how many women were choosing various treatment methods and whether they led to any differences in survival rates.

The study published recently inJAMA,Journal of the American Medical Association, found that while double mastectomies are increasingly popular, they do not seem to be associated with higher survival rates.

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The researchers studied a database of women in California who were diagnosed with early-stage breast cancer in just one breast in the past decade. They compared those who underwent a single mastectomy, those who had a double mastectomy, and those who had breast-conserving surgery with radiation. They looked at over 189,000 women for at least seven years each.   

One interesting finding was that double mastectomies have grown more popular in recent years, especially for women under 40. "The rates of double mastectomy to treat one-sided breast cancer have increased at a rate of 14 percent a year," says study coauthor Allison Kurian, MD, from the Stanford University School of Medicine.

MORE:What No One Tells You About Having Breast Cancer

But surprisingly, this drastic surgery did not lead to much higher survival rates. "Women who had double mastectomy did not seem to have any better survival than women who had the other two surgical procedures," says study coauthor Scarlett Gomez, PhD, research scientist at The Cancer Prevention Institute of California. In fact, there was no difference in mortality between double mastectomy and breast-conserving surgery plus radiation.

However, single mastectomy was actually associated with a higher mortality than the other two options. Why? According to the study, it might be due to outside variables. For instance, they found that women who had a double mastectomy tended to be non-Hispanic whites with a higher socioeconomic status and private insurance, while women who had a single mastectomy were more likely to be minorities with lower socioeconomic status and public insurance. Women with a single mastectomy were also less likely to be treated at a cancer institute and previous research shows that these women may have stronger barriers to access quality care. So it may be the case that single mastectomies are correlated with a higher mortality because of these confounding variables.

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"Although the rate of double mastectomy has increased substantially throughout the state of California over the last decade, women are not actually gaining any better survival because of this surgery," says Kurian. "And this is a surgery which has a higher complication rate, so it is somewhat concerning to see that there is no associated survival benefit in our study."

So does that mean you shouldn't get a double mastectomy? Not necessarily. The surgery is still a safe and effective way to reduce your risk of breast cancer in the unaffected breast (even if it doesn't significantly affect survival rate), and it's something that you and your doctor should discuss if you're curious about it. That said, it's also important to know that a double mastectomy isn't absolutely necessary if you and your doctor decide that breast-conserving surgery with radiation is a better option.

For now, Kurian says the medical community hopes to improve their communication with patients to better explain treatment options and how they will affect your risk and survival rate.






Video: Breast Conservation & Recurrence Risk

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Date: 15.12.2018, 14:27 / Views: 83332