Doubly Radical Decision - Preventive Mastectomies
If you knew
that your chances of contracting a deadly disease could be lowered to
almost nothing by a surgical procedure, what would you do?
That is the
question that many
face today. Studies are telling us that it is possible to bring the
risk of developing breast cancer down to almost nothing. The price to
pay for this increased security is the removal of both breasts.
A study reported in The Lancet gave 682 people who were at risk of carrying
one of the BRCA genes the opportunity to be tested. More than 250 of them,
48 percent of the women and 22 percent of the men, decided to have the
test. 51% of the women who found that they had the genetic mutation opted
for removal of both breasts to lower their chances of getting breast cancer.
A 1999 study
from the Mayo Clinic followed 639 women who had this procedure done between
1960 and 1993. The authors report, "Depending on the method used to calculate
the expected rate, the reduction in the risk of death was 81-94% for high
risk women who had undergone surgery."
of this study in The New England Journal of Medicine was accompanied
by an editorial entitled, "Prophylactic Mastectomy: The Price of Fear,"
in which Drs. Barbara Weber and Andrea Eisen help to put this research
and colleagues provide evidence that prophylactic mastectomy is
a very effective means of reducing the incidence of breast cancer
among women at increased risk for the disease. This can only be
viewed as good news for women who are considering this option, and
even better news for women who have already undergone the procedure.
... what the study illustrates most dramatically is the cost of
prophylactic mastectomy. Even in the face of an unprecedented 90
percent reduction in the incidence of breast cancer and of death
from breast cancer, the fact remains that this is a study of 639
women who, because of the fear of breast cancer, underwent a disfiguring
and potentially psychologically damaging operation. As a result,
instead of the 20 deaths related to breast cancer that were expected
during the period of observation, there were only 2. The saving
of those 18 lives is clearly important, but the 621 women who probably
would have survived without prophylactic mastectomy paid a price
that will be considered unacceptable in the future."
if someone had stood in front of these 639 women and told them
It is likely
that far fewer would have opted for the procedure.
- The statistics
showed that for each of them there was a three percent chance of breast
this means 20 women in the group of 639 would get breast cancer
both breasts reduced the odds that they would be in that twenty, but
after removing all of their breasts there would still be two deaths
from breast cancer.
can be frightening and breast cancer is always frightening, but basing
a radical surgical decision on fear is never a wise decision.
for breast cancer are improving almost daily. Doctors are moving away
from radical procedures. Lumpectomies have virtually replace mastectomies.
When a breast must be removed, surgeons attempt to leave as much muscle
and other tissue in place as possible. While doctors and breast cancer
patients are gratefully leaving this procedure behind, another trend seems
to be moving us back.
updated May 4, 2017
on the Web:
Mastectomy - Your Body