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Study Finds Rise in Choice of Double Mastectomies
By RONI CARYN RABIN
More women with breast cancer are choosing to have their healthy breast surgically removed along with their affected breast, a new study has found. Almost 5 percent of patients decided to have the radical procedure in 2003, up from just under 2 percent in 1998.
The study, published in The Journal of Clinical Oncology online, analyzed data from a small fraction of the estimated 200,000 women who receive breast cancer diagnoses in the United States each year. If the figures are accurate, 8,000 to 10,000 patients a year may be electing to have the procedure, called a contralateral prophylactic mastectomy.
â€œSome people may think itâ€™s kind of crazy, but you donâ€™t know what youâ€™re going to do until you yourself are faced with the situation,â€ said Darcy Long, 44, of Maple Grove, Minn., who had a double mastectomy after breast cancer was diagnosed in her right breast last July.
From the start, Ms. Long said; â€œThere was no question in my mind. I was going to have a mastectomy on both sides. I wanted to maximize my survivability, and I didnâ€™t want to ever think that I hadnâ€™t done everything that I possibly could to prevent this from coming back.â€
The studyâ€™s lead author, Dr. Todd M. Tuttle, chief of surgical oncology at the University of Minnesota Medical School, started the study because so many patients were requesting the procedure. Still, Dr. Tuttle said, he was surprised by the increase in contralateral prophylactic mastectomies, an upward trend that shows no sign of leveling off and is occurring even as the practice of breast-conserving surgery expands.
â€œThe comment patients make is, â€˜I just want to be done with it,â€™â€ he said. â€œThey never want to have another mammogram again; they never want to have another biopsy again.â€
He and other experts emphasized that though the removal of the healthy breast sharply reduced the risk of a new cancer developing in that breast â€” the risk is not zero because some tissue can remain â€” it was the cancer that had already been diagnosed that posed the greatest threat to a patientâ€™s life.
â€œFor the vast majority of our patients, this does not impact the chances of dying of breast cancer, and thatâ€™s the key thing here,â€ said Dr. Julie R. Gralow, the chairwoman of the communications committee of the American Society of Clinical Oncology and an associate professor of medical oncology at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle.
â€œMy first reaction to this study, because it came as a bit of a surprise, was, â€˜Oh, are we doing our job explaining that point to patients?â€™â€ Dr. Gralow said. â€œWe want to support women in doing what feels right to them. But our job is to make sure they have all the accurate information.â€
The study used data from cancer surveillance registries covering about a quarter of the United States to identify 152,755 patients whose cancer was diagnosed in one breast from 1998 to 2003. The rate rose steadily, with 4.5 percent of all patients who received breast cancer diagnoses in 2003 having the surgery, up from 1.8 percent in 1998.
The numbers were much higher among women who had the breast with cancer removed, rather than a lumpectomy. That group was much more likely to choose to have the healthy breast removed, as well. In that group, 11 percent chose a double mastectomy in 2003, up from 4.2 percent in 1998. Patients with Stage 1 breast cancer chose the procedure more often than those with more advanced cancer.
â€œWhat weâ€™re actually seeing is more and more women at the two extremes: either having minimal surgery, a lumpectomy, or having a bilateral mastectomy,â€ Dr. Tuttle said. â€œFewer women are having just one breast removed.â€
Younger women, white women and women with a previous cancer diagnosis were more likely to opt for a contralateral prophylactic mastectomy, the study found, as were women who had lobular histology, meaning the cancer started in the lobules or milk-making glands of the breast.
Though the researchers had limited information about the patients, Dr. Tuttle suggested that younger women might be choosing the procedure because their cancers tended to be very aggressive, and they had more years ahead of them in which a second cancer might develop.
Though all women with breast cancer are at risk of developing a second cancer in the uninvolved breast, the risk is slightly greater with lobular histology, Dr. Tuttle said, and white women may be more likely to carry genetic mutations associated with an increased risk of developing cancer in the contralateral breast.
Several developments may be driving the trend toward prophylactic mastectomies, experts said. More women are undergoing genetic testing after a diagnosis of breast cancer, and improvements in both mastectomy and breast-reconstruction techniques have made the option of a double reconstruction less daunting.
Doctors and patientsâ€™ advocates urged women considering the procedure to go for counseling and take their time before making a decision, noting that other risk-reducing options were available, like tamoxifen therapy for estrogen receptor-positive breast cancer and the use of more sensitive magnetic resonance imaging screening for earlier detection.
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I think maybe I would have both removed if I could.
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The investigators found that patients with serum 25-hydroxyvitamin D of approximately 52 ng/mL had a 50% lower risk for breast cancer than those with serum measuring less than 13 ng/mL. This level corresponds to a vitamin D intake of 4000 IU per day
Taking as much vitamin d daily as your body actually requires cuts your risk of BC by 50% but it also cuts your risk of other cancers so the total cancer risk reduction is around 77% It will also benefit your health in many other ways.
We don't have to be afraid of cancer. Our bodies are designed to cope with it and given regular SHORT exposure to sunlight will manage much better.
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I was diagnosed with Lichen sclerosus et atrophicus and later it got so bad (Phimosis and degeneration), that I opted to have it removed.
Doing some research into my family history revealed a great Grandfather on my Mothers side who bore a striking facial resemblance to me on the only surviving tinplate photo. It also came out that this man used to visit a herbalist regularly to by some form of soothing preparation for "something down his pants"! That is as much as I found out. I doubt if I had known about him years ago before my condition developed I would have elected to have my penis removed to avoid the condition later:-1
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If the removal of of a breast 'upped' my odds of living, I'd definitely have it done......I have a new generation of grandchildren.....2yrs, 8 months and 10 weeks. The thought of not seeing them grow up as I have the other 4 is unthinkable.