When it comes to breast cancer treatment, is a double mastectomy a good idea?

In In The News by Barbara Jacoby0 Comments

By: Elli Jacobs

From: smh.com.au

In 2013, Renee Gani, then 36, received the news every woman dreads. “Being large-busted, I always had a habit of checking myself,” she says. “I found a lump in my right breast and waited for a week hoping it would disappear.” But a biopsy confirmed it was indeed breast cancer.

“My immediate thought was to do everything possible to see my two boys grow up, so a preventive double mastectomy felt like the only way forward.”

Anecdotally, the incidence of women having the procedure has increased significantly over the past few years, says Professor Geoff Lindeman, a Melbourne oncologist and co-head of the breast cancer laboratory at The Walter and Eliza Hall Institute of Medical Research.

US research shows a threefold increase in preventive mastectomy over the past decade among women treated for early-stage breast cancer and a similar trend is likely to be occurring in Australia, says Lindeman.

For women with a previous breast cancer, the risk of developing another over the next 25 years are 30-40 per cent for BRCA1 and BRCA2 carriers and 15-20 per cent for non-carriers. Although Gani tested negative for the BRCA gene mutation, leaving her at average risk of contra-lateral, or opposite side, breast cancer, she still had concerns.

“Because my cancer was hormone-receptive, I wanted to remove such potential risks from my body, ” she says. “The side effects, including losing all sensation in my breasts, were a small price to pay for my peace of mind. Having an immediate reconstruction made me feel semi-normal again, and when I got my nipple tattoos I felt an extra spring in my step.” More women seem to be considering this additional surgery since Angelina Jolie went public as a BRCA1 gene mutation carrier in 2013, says Lindeman.

The coverage of Jolie’s condition educated women to seek genetic advice, says Dr Chantel Thornton, a specialist breast cancer surgeon at Epworth Hospital in Melbourne. But it also scared many women, influencing their decision to opt for preventive mastectomy.

Elizabeth Savina, however, chose a different treatment path when she faced a similar diagnosis at the age of 35. “At first I told my surgeon to remove both breasts. Being influenced by popular media, that’s what I thought women with breast cancer did.But when my surgeon explained that there was no good reason to remove a perfectly healthy breast and that I only had a 13 per cent chance of contra-lateral breast cancer, I chose to have a single mastectomy.”

Three years later, Savina hasn’t had a breast reconstruction, nor does she plan to. “While I was devastated when I first saw the mastectomy side post-surgery,” she says, “when I turned and saw the profile of my remaining breast I thought, ‘That still looks pretty hot!’ Having one natural breast has been a great comfort to me.”

While she says the decision as to whether to have a procedure or not is personal, Thornton cautions that if you’re at average risk of contra-lateral breast cancer, removing the healthy breast won’t improve your chances of survival. And she says a double mastectomy – especially when it involves reconstruction – comes with its own risks. “Recovery is longer, the implants could get infected, you may have chronic pain or non-healing wounds, and if there are any complications it may delay other treatments.”

She believes more women are choosing the procedure for a number of reasons, including fear of contracting another cancer because they’re still young, avoiding fresh anxiety with each mammogram, and having symmetrical breasts.

Thornton advises that the time to consider the aesthetic and psychological factors of a preventive mastectomy is once the existing cancer has been adequately treated.

Some key questions to ask your surgeon

• What are my surgery and treatment options?

• Which procedure should I choose and why?

• Will this procedure increase my chance of survival?

• What are its risks and side effects?

• Will it affect my fertility or ability to breastfeed?

• If the cancer returns, what further treatment options will I have?

Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.

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