Double Mastectomy Shows Same Benefit As Lumpectomy for Average Risk

Breast Cancer News
September 26, 2014
By: 
Robin Warshaw, Contributing Writer
Reviewed By: 
Lisa Jablon, MD

A recent study of California women with early-stage breast cancer showed that bilateral mastectomy has the same impact on survival as breast-conserving surgery, or lumpectomy, followed by radiation therapy.

With a sharp increase in the number of women choosing bilateral mastectomy – or double mastectomy, the removal of both breasts – when only one breast is affected by breast cancer, many want to know if that procedure helps survival compared to less-extensive surgeries.

Women at higher risk, such as those with BRCA gene mutations or strong family histories of breast cancer, may have more reason to consider choosing double mastectomy.

Background

Women diagnosed with early-stage breast cancer in one breast may have a choice of surgical treatments: lumpectomy to remove the tumor, plus radiation therapy; single mastectomy to remove the affected breast; or double mastectomy. Earlier studies show similar survival rates for people treated with lumpectomy and mastectomy.

Yet more women have been choosing double mastectomy, which has a longer recovery period and higher risk of complications. Experts believe this may relate to worry about future breast cancer developing or wanting more similar breasts after reconstruction. A small percentage of the increase may be due to genetic testing, as some carriers of BRCA gene mutations may decide to have preventive double mastectomy.

Goals

The researchers wanted to better understand the use and survival outcomes of double mastectomy. They also wanted to find out whether some people were being overtreated by having double mastectomy, based on the balance of its risks and benefits.

The study was designed to find out whether certain groups of people were more likely to choose double mastectomy and also learn whether there were differences in mortality, or deaths, within treatment types.

Design

Using a database containing nearly all cancer cases in California, the researchers analyzed surgical treatments for women with stage 0–III breast cancer from 1998 through 2011. The study evaluated use and results by age, diagnosis, socioeconomic status and other factors.

Results

The study looked at data for 189,734 women. Of those, 10,126 were younger than 40 years old at diagnosis.

Double mastectomy use rose from 2 percent in 1998 to 12.3 percent in 2011. The rate for women younger than 40 increased the most: from 3.6 percent in 1998 to 33 percent in 2011.

Despite the increased use of double mastectomy by women with early-stage breast cancer, the study showed no survival difference between double mastectomy and lumpectomy with radiation. Single mastectomy was associated with higher mortality than the other two surgical options, a finding which the researchers said could be due to socioeconomic factors.

Women who chose double mastectomy instead of lumpectomy with radiation therapy were more likely to

  • be younger than 50 at diagnosis
  • be non-Hispanic white
  • receive care at an NCI-designated cancer center
  • live in a neighborhood with higher socioeconomic status

Single mastectomy was most associated with

  • diagnosis at an age other than 50 to 64 years
  • Asian, Hispanic and American Indian race or ethnicity
  • being married
  • having public insurance or Medicaid
  • getting care at hospital serving people with less ability to pay for care

Compared with double mastectomy, women who chose lumpectomy treatment were more likely to be 65 or older, married, of a minority race or ethnicity, receive adjuvant therapy and not have private insurance. Non-Hispanic blacks more often chose lumpectomy over single mastectomy.

What This Means For You

Receiving a breast cancer diagnosis can create great anxiety. You may feel you need to make treatment decisions while you are still gathering and processing information, and while you are experiencing a lot of worry or distress. It may be helpful for you to read the free LBBC Guide to Understanding Treatment Decisions.

Your medical oncologist and breast surgeon should be able to explain your surgical options to you, based on your diagnosis. Take the time you need when talking with healthcare providers to understand your risk factors for recurrence based on treatment types, your family history and other factors, in order to reach an individual decision.

It may seem to make logical and emotional sense that one treatment would have better long-term survival than another, but this study offers scientific evidence that – for women at average risk – neither double mastectomy nor lumpectomy with radiation therapy is better than the other.

If you would like to talk with someone who has faced similar treatment decision-making, contact LBBC’s Breast Cancer Helpline. Our confidential service offers support and information to help you.

Kurian, AW, Lichtensztajn, DY, Keegan, THM, et al. Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011JAMA, 2014; DOI: 10.1001/jama.2014.10707

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention

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