That’s a scary number, especially when most of us know someone who has been diagnosed, or have faced breast cancer ourselves. The good news is that more breast cancers are discovered during the early stage, when they are more easily treated; and treatment is now more focused, more successful and more personalized. And while the overall rate of breast cancer is not becoming lower. It has remained stable.
Why then, are more women having mastectomies? Particularly considering that many women who could have lumpectomy with radiation in one breast are deciding to instead have both breasts removed.
New data from the U.S. Agency for Healthcare Research and Quality shows that the rate of mastectomy rose considerably—by 36%—between 2005 and 2013:
- The rate of bilateral mastectomies more than tripled, accounting for roughly a third of all mastectomies performed by 2013.
- Double mastectomies among younger women also increased. In 2013 women who had them tended to be about 10 years younger than those who had unilateral mastectomy (51 years compared to 61 years, respectively).
- The rate of women who had prophylactic mastectomy—those who did not have breast cancer—more than doubled.
- 45% of all mastectomies performed in 2013, both unilateral and bilateral, were done as outpatient procedures, without an overnight hospital stay.
Physicians and medical experts are alarmed at the rising rates of mastectomy; articles on this subject almost always include a quote by a clinician who cites similar survival statistics from lumpectomy with radiation or bilateral mastectomy. Certainly, women are concerned about survival, but we’re also concerned about other aspects as well. Women often report that they fear the long-term effects of radiation, the possibility of a future diagnosis in the opposite breast, and often want a better chance of symmetry by having both breasts reconstructed at the same time. Having faced one diagnosis, many women are willing to choose the more radical procedure (mastectomy) than facing more treatment and angst down the road.
Regarding the rise in prophylactic mastectomies, one obvious reason seems to be the so-called “Angelina effect.” (Actress Angelina Jolie had much publicized preventive bilateral mastectomies in 2013 after learning she had a BRCA1 gene mutation). Removing both breasts to reduce the risk of developing breast cancer caused by an inherited genetic mutation. Genetic testing is becoming more affordable and education about it is more available. So more women are being tested and finding that they are indeed positive for a genetic mutation that doesn’t guarantee but greatly raises the likelihood that they will develop breast or other cancer.
Most women who have early-stage breast cancer have a choice between the more conservative lumpectomy or more radical mastectomy. In many cases, however, bilateral mastectomy can be a wiser choice for women who are diagnosed in one breast and have a very high risk of contralateral cancer (in the opposite breast). Especially those who have been diagnosed more than once.
For some women, the choice to remove both breasts is a no-brainer; for others it can be excrutiating and emotionally devastating. No matter what the circumstances, like all medical decisions, it's one that is quite personal and best made with all the information and understanding needed to make the best possible decision.