Navigation Links
Increase seen in use of double mastectomy

Among women diagnosed with early-stage breast cancer in California, the percentage undergoing a double mastectomy increased substantially between 1998 and 2011, although this procedure was not associated with a lower risk of death than breast-conserving surgery plus radiation, according to a study in the September 3 issue of JAMA. The authors did find that surgery for the removal of one breast was associated with a higher risk of death than the other options examined in the study.

Randomized trials have demonstrated similar survival for patients with early-stage breast cancer treated with breast-conserving surgery and radiation or with mastectomy. However, previous data show increasing use of mastectomy, and particularly bilateral mastectomy (removal of both breasts) among U.S. patients with breast cancer. Evidence for a survival benefit with this procedure appears limited to rare patient subgroups. "Because bilateral mastectomy is an elective procedure for unilateral breast cancer [in one breast] and may have detrimental effects in terms of complications and associated costs as well as body image and sexual function, a better understanding of its use and outcomes is crucial to improving cancer care," according to background information in the article.

Allison W. Kurian, M.D., M.Sc., of the Stanford University School of Medicine, Stanford, Calif., and colleagues used data from the California Cancer Registry from 1998 through 2011 to compare the use of and rate of death after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy (removal of one breast).

The analyses included 189,734 patients. The researchers found that the rate of bilateral mastectomy increased from 2.0 percent in 1998 to 12.3 percent in 2011, an annual increase of 14.3 percent. The increase in bilateral mastectomy rate was greatest among women younger than 40 years: the rate increased from 3.6 percent in 1998 to 33.0 percent in 2011, increasing by 17.6 percent annually. Use of unilateral mastectomy declined in all age groups

Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute-designated cancer center; in contrast, unilateral mastectomy was more often used by racial/ethnic minorities and those with public/Medicaid insurance.

Compared with breast-conserving surgery with radiation, bilateral mastectomy was not associated with a mortality difference, whereas unilateral mastectomy was associated with higher mortality.

"In a time of increasing concern about overtreatment, the risk-benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient's preference for a morbid, costly intervention of dubious effectiveness," the authors write.

"These results may inform decision-making about the surgical treatment of breast cancer."

(doi:10.1001/jama.2014.10707; Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Contralateral Prophylactic Mastectomy: Is It a Reasonable Option?

In an accompanying editorial, Lisa A. Newman, M.D., M.P.H., of the University of Michigan, Ann Arbor, discusses the issues involved with the use of contralateral prophylactic mastectomy (risk-reducing mastectomy for the unaffected breast).

"The need for patients to be accurately informed regarding safe and oncologically acceptable treatment options is indisputable. The dense fog of complex emotions that accompanies a new cancer diagnosis can impair the ability to process this information. Patients should be encouraged to allow the intensity of these immediate reactions to subside before committing to mastectomy prematurely. Physicians should not permit excessive treatment delays to compromise outcomes, but the initial few weeks surrounding the diagnosis are more effectively utilized by time invested in patient education and procedures that contribute to comprehensive treatment planning as opposed to hastily coordinating impulsive, irreversible surgical plans."

(doi:10.1001/jama.2014.11308; Available pre-embargo to the media at

Editor's Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.


Contact: Jana Cuiper
The JAMA Network Journals

Related medicine news :

1. BASPCAN - UK-wide increase in number of children
2. MP3 song-searching can increase risk for drivers
3. Saliva test could dramatically increase detection of oral cancer
4. Regular jogging shows dramatic increase in life expectancy
5. Email vacations decrease stress, increase concentration, researchers say
6. Comorbidities increase risk of mortality in COPD patients
7. Could Eating Fast Increase Diabetes Risk?
8. For Dementia Patients, Feeding Tubes May Increase Bed Sores
9. Reported increase in older adult fall deaths due to improved coding
10. Chemotherapys effect on overall survival seems to increase based on tumor size
11. Dietary supplements increase cancer risk
Post Your Comments:
(Date:11/25/2015)... ... November 25, 2015 , ... Finnleo, a leader in the traditional ... models of traditional and far-infrared saunas. , For traditional saunas, Finnleo is ... traditional Finnish sauna wood, and Finnleo uses only European Grade A Nordic White Spruce ...
(Date:11/25/2015)... ... 26, 2015 , ... Ministers, senior government and UN agencies, ... Centres of Excellence, and public R&D institutions, civil societies and other partners gathered ... 5th African Network for Drugs and Diagnostics Innovation, ANDI, Stakeholders Meeting. The three- ...
(Date:11/25/2015)... ... November 25, 2015 , ... Lakeview Health, a Jacksonville-based drug ... their sobriety and show through pictures what a positive difference it makes. The ... with the hashtag #FacesOfGratitude on their Facebook, Twitter, and Instagram accounts. Short ...
(Date:11/25/2015)... ... November 25, 2015 , ... The McHenry County law firm of ... decision obtained by Attorneys Francisco J. Botto and Alex C. Wimmer. Attorneys Botto and ... Comm’n, 2015 IL App (2d) 130884WC. , According to court documents, Adcock testified that ...
(Date:11/25/2015)... (PRWEB) , ... November 25, 2015 , ... Beddit® has ... Beddit Classic sleep tracking systems. The new app features a more intuitive SleepScore™ that ... understand how well you slept. The SleepScore is created by a proprietary algorithm. Beddit ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... 25, 2015 Allergan plc (NYSE: ... Rugen Therapeutics, a start-up  biotechnology company focused on ... disorders and funded by the F-Prime Biomedical Research ... into an exclusive collaboration to support the discovery ... Disorders (ASD) and Obsessive Compulsive disorders (OCD). ...
(Date:11/25/2015)... 2015 USP 800 applies to all ... pharmacists, pharmacy technicians, nurses, physicians, physician assistants, home ... also covers all entities which store, prepare, transport, ... healthcare institutions, patient treatment clinics, physicians, practice facilities, ... --> What is the purpose of ...
(Date:11/25/2015)... 2015 Asia -based ... BioLight and the New Investors will make a direct ... a private placement. The financing will help IOPtima to ... used in the treatment of glaucoma, as well as ... IOPtimate™ system with the U.S. Food and Drug Administration, ...
Breaking Medicine Technology: