Sunday, October 06, 2013

Too much

I just had a conversation with someone I know who was recently diagnosed with breast cancer. From what I can tell, it's a fairly small, early cancer with no spread detected (as yet), so she would be a good candidate for lumpectomy, radiation, and hormonal therapy. But the woman I was speaking with is opting instead for a double mastectomy. Having both breast surgically removed. Her reason? So she doesn't ever have to deal with breast cancer again.

In my opinion, she is doing too much. And it bothers me. A lot.

I've been hearing a lot over the past few years about women who choose to have contralateral (both sides) prophylactic (preventative) mastectomy (removal of the breast), also known as CPM for short. It seems to be, for lack of a better word, a fad. It seems to be a choice for many women with all stages of breast cancer, including Stage O, Stage 1, and Stage 2, all of which can be treated with lumpectomy, radiation and hormonal therapy. But women are choosing the most extreme approach. Why?

It turns out there was a major study just published last month in the Annals of Internal Medicine (this link is to the abstract only). This study surveyed women who had chosen CPM. 94% of the women chose to have the procedure to "improve their chance of survival," and 98% to "reduce the risk that cancer will develop in the other breast." The only problem is, as the authors note, "CPM is not likely to improve breast cancer survival rates." If a woman has cancer in one breast, her chance of getting it in the second breast is only 4-5% in the next 10 years. So women are getting this extreme procedure, not for a physical benefit, but for a psychological one.

There are several interesting articles about this study online. In this article from Medscape Medical News, one of the study doctors is quoted as saying:
“Many women have unrealistic expectations of what having their opposite breast removed will do. We did a study that was published last year in which the women we interviewed thought their average risk of getting cancer in the opposite breast over 10 years was more than 30%, when the actual risk is about 4% to 5%. The take-home message from this study, which is a great study, is that physicians need to take time and explain the facts to their patients.”
Another issue is the potential of complications from the surgery, the recovery period from the surgery, and future issues such as "unplanned operations, less than ideal cosmetic results, sexual side effects, and self-image issues," said Dr. Attai, a breast cancer surgeon quoted in the article.

A second article, from the LA Times, discusses this same study. In this article, the author states:
...the women did not seem to fully grasp that they could keep their healthy breast and have the same long-term odds of surviving breast cancer. An editorial that accompanied the study noted that over a 20-year period, no more than 1% of those who decide to keep their healthy breast later die because their breast cancer has spread there.
I wrote several months ago about the celebrities who are having CPMs and making it seem so do-able and easy. This is another part of the picture. High-profile women with breast cancer are having these procedures, and regular women think, "well, if they can do it, why not me?"

In the end, women need to make their own decisions. I tend to err on the side of being conservative with medical issues. Others would choose to err on the side of being more bold. Still, it makes me sad to think that women are so afraid of breast cancer that they would choose to cut off their breasts. It just makes me sad.

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