More Women Choosing 'Preventive' Double Mastectomy

By Kathleen Doheny
HealthDay Reporter
Monday, October 22, 2007; 7:00 PM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

MONDAY, Oct. 22 (HealthDay News) -- Women diagnosed with breast cancer who have a mastectomy are increasingly choosing to have their other, healthy breast removed as a preventive measure.

The rate of the procedure, called a contralateral prophylactic mastectomy, more than doubled from 1998 to 2003, according to a new study.

The increase concerns study lead author Dr. Todd Tuttle, chief of surgical oncology and associate professor of surgery at the University of Minnesota Medical School. He believes many women may be making the choice for inappropriate reasons, and removing the other breast may be unnecessary.

"We don't know why women are choosing this," he said. "If they are choosing it because they think it will improve their breast cancer survival, I am very concerned. It won't improve their overall survival."

Research has failed to show a survival benefit with the second mastectomy, Tuttle said in his report, published online Oct. 22 in the Journal of Clinical Oncology. The reason: The risk of cancer spread from the original breast to other body sites often exceeds the risk of getting cancer in the second breast, he said.

Tuttle and his colleagues evaluated 4,969 women who chose contralateral prophylactic mastectomy, looking at the Surveillance, Epidemiology and End Results (SEER) database. From 1998 to 2003, the rate of preventive mastectomy for the second, healthy breast increased from 4.2 percent to 11 percent. Those most likely to choose the preventive operation were younger women and non-Hispanic whites.

Tuttle said there are times when a second mastectomy is appropriate. "I will tell patients to consider it strongly if they have a known genetic mutation -- BRCA1 or 2 [the so-called breast cancer genes] -- or a very strong family history, such as first-degree relatives who develop breast cancer before age 50," he said.

"Sometimes, we will recommend it in those who need mastectomy on one side and because of body symmetry issues, the other breast would be too big" once the cancerous breast is removed, he added.