Double Mastectomy Increasingly Popular Breast Cancer Treatment

For people watching the celebrity headlines that actress Christina Applegate underwent a double mastectomy, the option may seem extreme.

But increasingly women who have an elevated genetic risk for breast cancer are choosing mastectomies to remove not only both breasts but the risk.

They are known as preventive mastectomy or prophylactic mastectomy because of their protective effect.

Applegate, 36, has a genetic predisposition for breast cancer.  

She carries the BRCA1 gene mutation, meaning she has as much as an 85 percent increase risk of the disease. Her mother also had the disease, so she chose the more radical approach to avoid dying of breast cancer.

Dr. Brian O’Hara of the Carol M. Baldwin Breast Care Center at StonyBrook University Medical Center tells Newsday, "As difficult as it is for women to make this decision, I've found that as the years go on, these are some of the happiest patients in my office because the burden of an expected cancer has been lifted -- and they are free.”

A University of Minnesota study found that double mastectomies increased by 150 percent between 1998 and 2003, in women diagnosed with cancer in only one breast, as Applegate had been.  

Many times, women who initially opt to have one breast removed, later chose to have the healthy one removed in a separate procedure.

A woman is much more likely to have a breast removed as opposed to a lumpectomy after a diagnosis that includes an MRI, which is more sensitive than a mammogram.

A report published last year in the New England Journal of Medicine (NEJM) , finds that just more than three percent of patients had a second tumor detected using MRI than traditional mammograms.

MRI is also more likely to find false positives.

The Mayo Clinic reports the number of women opting for mastectomies began rising after magnetic resonance imaging became available in 2003.

In that year 44% of women who had an MRI had mastectomies compared to 28 percent who had no MRI.  

In 2006, 52 percent of women who had an MRI had mastectomies, compared to 41 percent of women who had no MRI.

More sophisticated technologies can find cancers sooner, and coupled with advances in reconstructive plastic surgery, can make the decision more appealing for a women whose fear of cancer returning outweighs concerns about appearance.

During reconstructive surgery, doctors reconstruct a breast by taking skin from the stomach, buttock or back, and reconstruct the chest area over a saline implant.

A recent study in the International Journal of Cancer found that 18 percent of women who find these mutations decide to have a double mastectomy, even if they have not been diagnosed with cancer.

A report last year in the Journal of Clinical Oncology finds the rate for double mastectomy has doubled since 1998.

That may be overdoing it.

Among women with cancer in one breast, the risk of developing a tumor in the other breast is less than 1% a year, says Isabelle Bedrosian of Houston's M.D. Anderson Cancer Center to USA Today.

Dr. Bedrosian says that taking the other breast has no impact on survival for the original cancer.  She believes that patients should opt for hormone therapy over additional surgery.

Applegate had already had two lumpectomies after early-stage cancer was detected in one breast. Second lumpectomies re not uncommon. 

But she told Good Morning America that she opted for the double mastectomy after learning she had a genetic mutation, which is only rarely found in about five to seven percent of breast cancers. #