Young Women Can Save a Breast

Breast cancer risk overestimates may be leading to contralateral prophylactic mastectomies

(RxWiki News) You may recall that Angelina Jolie recently had a double mastectomy to reduce her risks of developing breast cancer. Researchers have discovered that young women are opting for similar operations to protect themselves.

According to a new study, young patients with early breast cancer are having both the affected as well as the other breast removed in the belief that the operation will limit their risks of new cancers.

Researchers learned that most of the women choosing this path overestimated their risks of cancer developing in the other (contralateral) breast.

Removing the healthy breast is called contralateral prophylactic (preventive) mastectomy (CPM).

"Have an in-depth conversation with your doctor about your cancer risks."

Shoshana M. Rosenberg, ScD, MPH, a researcher at the Harvard School of Public Health, led this study to better understand why women choose to have CPMs.

While CPM does reduce the risk of cancer in the healthy breast, women without any genetic predispositions have relatively low risks for contralateral breast cancer.

“Most young women with early stage breast cancer have a risk for developing cancer in the contralateral (other side) breast that is only slightly higher than a similarly aged female population as a whole, roughly 0.5 to 0.75 percent per year (5.0 to 7.5 percent over 10 years),” Patrick D. Maguire, MD, a radiation oncologist with Coastal Carolina Radiation and Oncology in Wilmington, NC, told dailyRx News.

There has been an upswing in the number of young women choosing CPM. “In the late 1990s, between 4 percent and 6 percent of women who had mastectomies also underwent CPM, whereas in more recent years the reported range has increased to between 11 percent and 25 percent, a 3- to 4-fold change,” the study authors wrote.

This study included 123 young women diagnosed with early-stage (stage l or ll) cancer in one breast only who had both breasts removed between September 2006 and November 2010.

The median age at the time the women were diagnosed was 37, with the range being between 26 and 40 years.

In terms of risk factors, 26 percent of the participants had a first-degree relative (mother, sister) and 62 percent had a second- or third-degree relative who had been diagnosed either with breast or ovarian cancer.

About 25 percent of the women had mutations in a BRCA gene, something that increases a woman’s risk of both breast and ovarian cancer.

Participants completed a 23-question survey that covered what influenced their decision to have the double mastectomy, and addressed their knowledge and perception of cancer risks and breast cancer worry.

Most (98 percent) of the women said they chose the surgery to reduce their risks of contralateral breast cancer; 94 percent indicated they wanted to improve their survival and 95 percent listed peace of mind as the reason for having the CPM.

Women with BRCA mutations tended to accurately understand their risks of developing contralateral breast cancer. Women without the genetic mutation overestimated their risks, the researchers discovered.

Most women (about 72 percent) recognized that CPM probably would not help them live longer.

The vast majority (90 percent) of the women said they would choose a CPM if they had to make the decision again.

Dr. Maguire said this study corroborates what physicians are seeing in the clinic. “A relatively large proportion of these young women opt for contralateral prophylactic (preventative) mastectomy, despite apparently knowing that the surgery will not improve their survival,” he said.

“One wonders to what extent the depth and breadth of conversation between doctor and patient for ‘informed decision making’ factors into these ultimately very personal and deeply felt choices,” said Dr. Maguire, who was not involved in the study.

The authors said that the study highlights “...the fact that many women have misperceptions about breast cancer risk. We believe that this points to a need for better risk communication strategies in an effort to ensure that treatment decision making is truly evidence-based while remaining patient-centered."

This study was published September 16 in the Annals of Internal Medicine.

Susan G. Komen for the Cure was the primary funding source for this study. No conflicts of interest were reported.

Review Date: 
September 16, 2013