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Why mastectomies are on the rise

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Mastectomies are back in vogue: Blame it on celebrities such as E! talk show host Giuliana Rancic and comedian Wanda Sykes, who appeared to bounce back easily after their recent double mastectomies and reconstruction for early-stage breast cancer in one breast. Or blame it on the overwhelming need to have some peace of mind after receiving a frightening breast cancer diagnosis.

Regardless of the reason, surgeons have seen a surge in requests from breast cancer patients who opt to have both breasts removed (including the one that’s cancer-free) rather than removing just the malignant lump in one. That’s despite findings from seven large clinical trials, which showed that, for tumors that hadn’t spread beyond the breast, mastectomies didn’t provide additional benefits over more conservative surgery — called a lumpectomy — followed by radiation.

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In fact, a study published last Monday in the journal Cancer suggests that breast cancer patients who opt for lumpectomies with radiation might have a 14 percent smaller risk of dying of breast cancer compared with those who have mastectomies.

“It’s a nice study,” said Dr. Mehra Golshan, director of breast surgical services at Dana-Farber/Brigham and Women’s Cancer Center, “but it’s hard to imagine that less surgery with radiation gives a better outcome.” At the minimum, the two types of surgery offer the same shot at survival, he added.

So why are women still choosing mastectomies?

“They’re worried about the cancer coming back in the breast or occurring in the opposite one,” Golshan said. “I spend a lot of time counseling women about this, telling them that we’ll monitor them closely through frequent screenings.” But many don’t want to live with the uncertainty.

Women with breast cancer gene mutations — which account for 7 to 9 percent of all breast cancers — should be counseled to consider a double mastectomy because they’re at greater risk of developing a metastatic tumor, he added.

But most of the rise in mastectomies has stemmed from a sharp increase in the diagnosis of the tiniest cancers — stage 0 or “in situ”— which are self-contained and are considered by some oncologists to be pre-cancers because they may not ever grow and spread into breast tissue. With higher quality imaging, some 60,000 women now get diagnosed with these in situ cancers every year compared with fewer than 7,000 to 8,000 a year in the early 1980s. While women with these cancers are offered either surgical option, many choose mastectomies; with full breast removal, the odds are less than 1 percent that a woman will have a local recurrence near the removed breast tissue, according to Golshan, while with a lumpectomy, a local recurrence happens 5 to 6 percent of the time.

These recurrences are highly treatable, Golshan said, and rarely life-threatening, but many women simply don’t want to face the possibility of more breast cancer or more treatment.

That certainly makes sense except that no surgery — no matter how extreme — will ensure a cancer-free life. Cancer is an insidious disease that can crop up at any time, in any organ, and in any person no matter how much they exercise, eat right, and follow a healthful lifestyle.

No doubt, oncologists could do a better job calming women’s fears and educating them on the long and painful recuperation period involved with breast reconstruction following a mastectomy. “It’s a good three to six months before a woman feels like herself again,” Golshan said.

While surgeons can preserve the nipple and provide more natural-looking results these days, the reconstructed breast feels somewhat numb to the touch, which often reduces sexual pleasure. “Not an insignificant minority of patients have told me when all is said and done that they wouldn’t have gone through it had they known what it would be like,” Golshan said.

shiplesp: Fear is a powerful motivator.

purplecow89: Has it occurred to anyone that it’s not fear of breast cancer itself or fear of recurrence that leads women to this decision, but not wanting to live the rest of their lives being closely monitored through frequent screenings — having their health interests and a lot of time, money, energy, and trouble devoted to Breast Watch?

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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