Contralateral prophylactic mastectomy, in which the healthy breast
is removed along with the cancerous breast, has been increasing over the
last decade, in part fueled by celebrities' stories and social media
The aggressive procedure is often recommended for women with a
genetic mutation that puts them at high risk of developing a second
cancer. But for women at average risk, the surgery offers little
‘About 44% early stage breast cancer patients considered having double mastectomy and one in six received it.’
Nearly half of early stage breast cancer patients considered having
double mastectomy and one in six received it - including many who were
at low risk of developing a second breast cancer, a new study finds.
Many patients who chose double mastectomy demonstrated little
knowledge of the lack of benefit this aggressive procedure has for most
"That one in six breast cancer patients chose bilateral mastectomy is
really striking. We knew it was increasing, but I don't think many of us
realized just how frequent this is," says study author Reshma Jagsi, professor and deputy chair of radiation oncology at the
University of Michigan.
In the new study, published in JAMA Surgery
surveyed 2,578 women from Georgia and Los Angeles who had surgery for
early stage breast cancer in one breast. Overall, 44% said they
considered double mastectomy.
Patients were grouped based on their genetic risk of developing
cancer in the unaffected breast. A quarter of the higher risk patients
underwent double mastectomy, and so did 14% of those at average
Women were also asked whether contralateral prophylactic mastectomy
improved survival or prevented cancer from returning. The answers
demonstrated poor understanding of the surgery's benefits.
Among patients who considered double mastectomy, only 38%
knew it does not improve survival for all women with breast cancer.
Almost all patients said peace of mind motivated them to choose double
"At a time when emotions are running high, it's not surprising that
newly diagnosed breast cancer patients might find it difficult to absorb
this complex information. It seems logical that more aggressive surgery
should be better at fighting disease - but that's not how breast cancer
works. It's a real communication challenge," Jagsi says.
When patients perceived that their surgeons recommended strongly
against contralateral prophylactic mastectomy, most heeded that advice:
only 2% of these women went on to choose the procedure. The rates
were higher among women who perceived no surgeon recommendation, with
one in five choosing the procedure - even if they were at average risk
of a genetic mutation.
Because the study asked patients to report their surgeon's
recommendations, it's possible some surgeons did recommend against
double mastectomy but that patients failed to hear or understand.
"As physicians, we want to be respectful of our patients'
preferences and values. We don't want to alienate patients who are
already in a stressful situation. We want them to trust us," Jagsi says.
"When a patient comes in saying she has already decided on double
mastectomy, it can be challenging to strike that balance between
respecting her preferences and adequately conveying why the medical
community in general doesn't think it's necessary," she adds.
The study authors call for better communication training for
physicians to help them navigate these difficult conversations more