New study questions need for many double mastectomies

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Capital News Service
LANSING – A new study from the University of Michigan’s Comprehensive Cancer Center shows that 70 percent of breast cancer patients who undergo double-mastectomy surgery have no clinical reason for doing so.
The study attributes that finding primarily to psychological factors, such as fear of cancer recurrence.
Sarah Hawley, a U-M professor and co-author of the study, said removing both breasts is a radical step that’s unnecessary for most patients.

“Women appear to be using worry over cancer recurrence to choose a double mastectomy,” Hawley said. “This doesn’t make sense because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast.”
The study reported on 1,446 women who had been treated for breast cancer and who hadn’t had a recurrence. It found that 7 percent of those patients opted to have both breasts removed. Among women who had a mastectomy, nearly one in five had a double mastectomy.
The removal of both breasts at the same time requires a more serious operation, with a longer recovery period and a greater risk for complications.
The U-M center has received a $13.6 million grant from the National Cancer Institute to examine how patients make breast cancer treatment decisions, how doctors make treatment recommendations and how to improve the process for better outcomes.
According to Steven Katz, co-director of the socio-behavioral program at the center, women’s health would be greatly improved by finding ways to individualize cancer treatments.
Treatment options vary based on the type and aggressiveness of the disease, family and genetic history, and lifestyle.
“This program is about helping patients and their doctors avoid doing more harm than good on the journey from treatment to recovery from a diagnosis of breast cancer,” said Katz.
Hawley said it’s important to better educate women as to why a double mastectomy won’t often prevent cancer from coming back or the development of new cancers. In fact, she said that since there is a greater risk of death in such an extreme surgery, it isn’t always the safest option.
“I believe surgeons are telling their patients that a double mastectomy won’t reduce their risk of recurrence and that it is associated with higher morbidity,” she said. “But this procedure is still done and it’s done in women who don’t need to have it done.
“A decision tool like ours will solicit common misconceptions about breast cancer treatment and give women feedback to help them fully understand the options and risks involved,” Hawley said.
According to Hawley, she and the other authors hope to develop a website that would explain the risks and why the surgery may not be required.
Meanwhile, cancer centers throughout the state are making changes that can help alleviate some of the fear that may cause women to seek radical preventive surgery.
The Comprehensive Breast Center at St. Mary’s Health Care, based in Grand Rapids, has redesigned its breast cancer patient services in recent years by assessing risk factors alongside mammograms.
“We are pro-actively screening the patients in our service area for their breast cancer risk,” said Jamie Caughran, medical director of the center. “This way we may provide them with breast cancer screening that is specific to their own risk level, not simply standard screening practices.”
The center also matches newly diagnosed patients with cancer support groups.
Examples include the Just For Us breast cancer organization through McLaren Health Care in Petoskey and Gilda’s Club of Metro Detroit, based in Royal Oak with locations in Grand Rapids.
Such groups provide an “emotional supplement” to treatment, and hopefully relief of anxiety, the Gilda’s Club said.
And according to the Department of Community Health, early detection is the best way to prevent major surgeries in the first place.
The five-year survival rate among women whose breast cancer has not spread beyond the breast at the time of diagnosis is 98.6 percent, said the department.

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