Bioethics Blogs

Weighing Surgical Options for Breast Cancer

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An increasing number of women with cancer in one breast are choosing to have both breasts surgically removed in hopes of reducing the chance of developing cancer in the unaffected breast. But does this approach—called bilateral, or double, mastectomy—really improve the odds of survival? A new NIH-funded study indicates that, for the vast majority of women, it does not [1].

A research team led by Allison Kurian, an oncologist at Stanford University School of Medicine, and Scarlett Gomez, an epidemiologist at the Cancer Prevention Institute of California in Fremont, used the California Cancer Registry to study the 10-year survival outcomes of patients diagnosed with early-stage cancer (stages 0–III) in one breast, between 1998 and 2011.

In this observational study, the researchers compared the outcomes of almost 190,000 women who chose one of three treatment options. The first is a lumpectomy, in which the surgeon removes the cancerous tumor and surrounding tissue, but preserves the rest of the breast. This is followed by radiation treatments. The second option is a unilateral, or single, mastectomy, in which the entire breast is removed. The third approach is bilateral, or double, mastectomy, which removes both affected and unaffected breasts.

The researchers documented that among women with early-stage breast cancer in this study, the rate of bilateral mastectomy jumped from 2 percent in 1998 to 12.3 percent in 2011. Among breast cancer patients age 40 and younger, that trend was even more dramatic, soaring from 3.6 percent in 1998 to 33 percent in 2011. The women most likely to choose double mastectomy were non-Hispanic whites of higher socioeconomic status with private health insurance.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.