What a New Double Mastectomy Study Means for Patients

Expert insight on breast cancer treatment

Woman with female doctor

If you are diagnosed with breast cancer, your treatment plan starts with open, honest conversations with your physicians and surgeons.

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For one thing, you’ll want to discuss surgical options. Are you a candidate for breast-conserving surgery in combination with radiation?  Or should you consider mastectomy, with or without breast reconstruction?

Numerous studies have shown both of these approaches are effective in treating breast cancer. With effective options available, you need to weigh their advantages and disadvantages — both physical and psychological.

In addition, studies have shown that a small but growing number of breast cancer patients are choosing to have a bilateral (double) mastectomy, a “prophylactic” or preventive surgery that removes the non-diseased breast as well as the diseased breast.

Most recently, a new retrospective study — which looks at past outcomes over an extended time period — confirms what surgeons have been telling their patients for years: A prophylactic double mastectomy won’t improve your long-term survival compared with breast-conserving surgery.

“The take-home message for most women is this: Removing a normal, healthy breast does not improve your long-term survival.”

Stephen Grobmyer, MD

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Director of Breast Services

What the study says

The study included data on 189,734 women with early-stage breast cancer over the course of 13 years. Researchers compared their survival rate at the 10-year mark.

According to the results, women who had a lumpectomy had a survival rate of 83.2 percent. Those who had both breasts removed through a double mastectomy had a survival rate of 81.2 percent. In addition, those who had a single mastectomy — removing the diseased breast only — had a survival rate of 79.9 percent.

If you’re a patient, don’t let these small differences frighten you. It’s valuable to note that the numbers actually are similar. And because this is a retrospective study — not a carefully controlled clinical trial — it’s important not to make too much of the differences in numbers. The researchers couldn’t control all of the factors that might have affected the numbers, from patient compliance to their access to high-quality care. Numerous other clinical studies have demonstrated that patients having lumpectomy and radiation versus mastectomy have equivalent survival.  

The take-home message for most women is this: Removing a normal, healthy breast does not improve your long-term survival compared with other options. This data matches the advice many surgeons have been giving patients for a long time.

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Why do some women consider prophylactic mastectomy?

Many people see results such as these and ask, “Why is double mastectomy an option at all?”

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The answer is that medicine is not one-size-fits-all, and long-term survival rate is not the only factor in a woman’s treatment decision.

Take genetic mutations, for example. For women with BRCA1, BRCA2, PTEN and other genetic mutations, the lifetime risk of developing breast cancer is so high that a preventive double mastectomy is worth discussing. Keep in mind those cases — such as the high-profile example of Angelina Jolie — are not necessarily the same as the ones covered in this new research. They’re less common, but when they occur, the risk for developing a cancer in the other breast is higher.

Even in patients without genetic mutations, women may have other reasons for choosing a double mastectomy. One example is a desire for symmetry following reconstruction. Others may choose a double mastectomy because of anxiety over lifelong monitoring for cancer, including the fear of multiple biopsies based on their prior experiences. Others have a long history of difficult-to-interpret breast imaging exams and repeated call-backs for imaging.

In other words, for some women, the decision may be about quality of life, not just survival rate. It’s our job in those cases to educate patients about the long-term implications of any option. A prophylactic mastectomy is a permanent alteration of your body, so it’s not a decision anyone takes lightly.

For most women in the United States with early-stage breast cancer, breast conservation is still the treatment of choice, and this new research highlights why. But because so many factors go into a woman’s treatment choice, we’ll continue to have those open, honest discussions — including the strengths and drawbacks of all available options.

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Stephen Grobmyer, MD

Stephen Grobmyer, MD, is Section Head of Surgical Oncology and the Director of Breast Services at Cleveland Clinic.
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