Why Are Double Mastectomies Increasing?

Pink ribbon signifying breast cancer awarenessYounger patients increasingly having both breasts removed after breast cancer diagnosis.

In some cases, a double mastectomy is the best way to help women who have breast cancer. However, a disturbing trend is emerging.

A new study shows that the number of double mastectomies among younger women who have cancer in only one breast is on the upswing, especially in certain states. The practice is not recommended except in certain situations.

Senior author Ahmedin Jemal, DVM, PhD, commented in a press release, “There might be differences in culture, there might be differences in provider recommendations.” However, he also noted that surgeons are paid more for a double mastectomy.

Dr. Jemal is an epidemiologist and the vice president of surveillance and health services research at the American Cancer Society.

Contralateral prophylactic mastectomy is the practice of removing a healthy breast as well as the breast affected by cancer.

Neither the American Board of Internal Medicine nor the American Society of Breast Surgeons recommend this practice except in situations where a woman is at high risk. A mutation in the BRCA1 or BRCA2 genes, for example, increases the risk of a second cancer. In those situations, the second mastectomy may make good sense.

Dr. Jemal and colleagues analyzed data on 1.2 million women age 20 and older. All the women had been diagnosed with early stage breast cancer in one breast between January 1, 2004 and the end of 2012. The study included women in all states except Illinois, Kansas, Maryland, Minnesota and Vermont.

Dr. Jemal and colleagues found 58.4 percent of the women had a lumpectomy (tumor removal) in the affected breast. The rate of double breast removal increased between 2004 and 2012 from 3.6% to 10.4% for those 45 years or older and from 10.5% to 33.3% for those aged 20 to 44 years.

In the states of Colorado, Iowa, Missouri, Nebraska and South Dakota, nearly half the women had double mastectomies. The rate of double mastectomies was highest among younger women (under the age of 45).

The areas with higher rates of double mastectomies do not have high rates of reconstructive surgery. This suggests that women are not making the choice to have symmetrically reconstructed breasts.

Dr. Jemal and coauthors commented in the study, “Patients should be educated about the benefit and harm of a contralateral prophylactic mastectomy for informed decision making.”

The study was published in the March issue of JAMA Surgery.
Information about study funding and conflict of interest was not available.
New York Times, “More Women With Breast Cancer Opt to Remove Healthy Breast”
https://www.nytimes.com/2017/03/29/well/live/more-women-with-breast-cancer-opt-to-remove-healthy-breast.html?module=WatchingPortal®ion=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=7&version=internal&contentCollection=www.nytimes.com&contentId=http://www.nytimes.com/2017/03/29/well/live/more-women-with-breast-cancer-opt-to-remove-healthy-breast.html&eventName=Watching-article-click
JAMA Surgery, “State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012”
http://jamanetwork.com/journals/jamasurgery/article-abstract/2613702
Written by: Beth Greenwood, RN | Medically reviewed by: Dr. Robert Carlson, M.D.