It has emerged as bold, brave and sensible: Having both breasts removed when cancer shows up in just one of them.
But in fact, it’s usually not a smart decision, research has shown. Double mastectomies when cancer is present in only one breast, also known as contralateral prophylactic mastectomy, or CPM, have skyrocketed in recent years. And while actress Angelina Jolie may have garnered headlines and respect from women nationwide for putting her life before vanity, celebrities like herself inadvertently have scores of women choosing this procedure when their doctors don’t inform them that the risks of such surgeries likely outweigh the benefits.
A study published Wednesday in JAMA Surgery showed that one in five women who did not receive advice from their surgeons on whether CPM was warranted went ahead and had the procedure done anyway.
Of almost 2,600 women surveyed who had breast cancer surgery, more than 2,400 women had cancer in just one breast. Overall, 44 percent considered having both breasts removed, and only 38 percent said they knew that CPM does not improve survival for all women with breast cancer.
Overall, 17 percent of the women chose to have CPM, and two-thirds of them did not have a high genetic risk or BRCA1 or BRCA2 mutation putting them at high risk. Only 40 percent said their surgeon recommended against the surgery, and of those, only 12 percent went ahead with it anyway.
“When patients do not receive a surgeon’s recommendation against it, even patients without a high genetic risk for a second primary breast cancer chose CPM at an alarmingly high rate (nearly one in five). However, CPM rates are very low among patients who report a surgeon’s recommendation against it,” the authors wrote. “Our findings should motivate surgeons to broach these difficult conversations with their patients, to make their recommendations clear, and to promote patients’ peace of mind by emphasizing how other treatments complement surgery to reduce the risk of both tumor recurrence and subsequent cancer development.
“These findings should also motivate efforts to inform and support surgeons in this challenging communication context, understand surgeons’ perspectives more fully, and design physician-facing interventions to reduce excessive treatment.”
The JAMA study was conducted by Dr. Reshma Jagsi of the University of Michigan, Ann Arbor, and colleagues. The survey sample included women from Los Angeles County and the state of Georgia.
Earlier this year, research showed that rates of CPM have more than tripled from 2002 to 2012. That research, conducted by senior author Dr. Mehra Golshan of Brigham and Women’s Hospital and colleagues, was published in March in Annals of Surgery.
“Patients and caregivers should weigh the expected benefits with the potential risks of (CPM), including prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and effects on self-image,” Golshan said in a Brigham news release. “Women with unilateral breast cancer undergoing (CPM) continue to report a desire to extend life as one of the most important factors leading to their surgical decision. Understanding why women choose to undergo (CPM) may create an opportunity for health care providers to optimally counsel women about surgical options, address anxieties, discuss individual preferences, and ensure peace of mind related to a patient’s surgical choice.”
Some women are choosing to have a more perfect pair of breast reconstructed, and are saving their nipples after CPM for such surgeries, according to BreastCancer.org.