Why more women are choosing to have prophylactic mastectomies

May 31, 2013

When actress Angelina Jolie decided to have her breasts surgically removed to prevent her from getting breast cancer, it brought unprecedented attention to the growing trend of prophylactic mastectomies. Lorraine Rapp and Linda Lowen, hosts of WRVO’s health and wellness show, “Take Care,” spoke with Dr. Ann Partridge, a medical oncologist and Harvard professor, about why more women are electing to have this surgery.

Lorraine Rapp: Why do you think these types of surgeries are on the rise?

Partridge: There are two really main reasons or two main populations that are considering prophylactic mastectomies or taking off one of more breasts for prevention rather than when cancer has been diagnosed. And one is survivors, so women who've already had a cancer. And for those women, there is a dramatic increase in this and some of that is due to the fact that those women do have a genetic mutation that suggests that they have a dramatically increased risk of new breast cancer in the other breast in their lifetime. So they've already been hit with one cancer and they say "I don't want to do that again." That's actually the minority of breast cancer survivors, though, and many women are taking off the other breasts in the absence of this of this markedly heightened risk. The second population is women who've never had cancer and they're at risks because they have breasts and as women get older, risk increases. And those women are typically those that have a strong family history of breast cancer or a known genetic predisposition. And those women do it obviously to reduce their risk, although there are alternatives to this. And having bilateral mastectomies, which is taking both breasts off, is fairly drastic. So a lot of women really need to think this through and decide if it's the right thing for her.

Linda Lowen: How does the attitude of the doctor influence a woman's decision?

Partridge: Most of us physicians do try and help patients figure out what's the best fit for them. We try to practice evidence based medicine, which is which procedure or strategy is shown to have the best outcome medically, and then we try to practice, combined with that, value based medicine, which is "okay, there are choices, which one fits with your preferences and values best?" And it's interesting because we see very different patients. Some patients do everything they can to have breast preservation, that is hold on to their breasts, even when they have a cancer. And many women we can do that. And some women come in and say "take them both off; I don't care about them" once they have cancer or if they realize there's a risk. So we have to learn about helping both situations and help each of those patients to see the other side and say "is this decision still right for me?"

Linda Lowen: If you have a first degree relative, you have a mother or a sister who has been diagnosed, or someone who has died of breast cancer, that's going to influence you tremendously. Talk about the influence of family history.

Partridge: A woman's personal experience in her family or herself has a profound influence on how a woman views these issues. Huge impact. And I try to say when I counsel patients that you're not your mother and things are different, but I also empathize that trying to prevent a bad outcome from that person might be including having to go through that again or ever, even if there's no evidence that it's going to impact on that woman's survival. Even though we've been studying this for many, many years and we have good data, studies have suggested that taking off a healthy breast has never been shown to really have an impact on a woman's survival. Does that mean that it never helps a woman? Absolutely not. It probably does help many women when it's appropriate. What it means is that of the women who choose to take off a healthy breast or both, for some of those women, they might have been diagnosed with breast cancer in that breast, and we would have caught it early and they would have been cured. And for some of those women, they may never have gotten a cancer. So showing how we impact on survival has not been evident yet. We in general, try to reserve the recommendation to take off a breast to women who are at very high risk.
 

More of this interview can be heard on "Take Care," WRVO's health and wellness show, Sunday at 6:30 p.m.  Support for this story comes from the Health Foundation for Western and Central New York.