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 recent 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."

The publication 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 in perspective.

"Hartmann 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."

What if someone had stood in front of these 639 women and told them

Statistics can be frightening and breast cancer is always frightening, but basing a radical surgical decision on fear is never a wise decision.

Preventive drugs are being developed. Tamoxifen, for example, has been found to decrease breast cancer incidence by up to 50 percent in high-risk women. Treatments 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.