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Most Cancer Survivors Would Sacrifice Healthy Breast Again: Study

By Ellin Holohan
HealthDay Reporter

FRIDAY, April 29 (HealthDay News) -- Despite concerns regarding appearance, few breast cancer survivors who opted for a double mastectomy as a precautionary measure regretted their decision decades later, a new study finds.

Researchers at the Mayo Clinic in Rochester, Minn., questioned hundreds of women who sacrificed a healthy breast in the hope of avoiding another cancer. Twenty years after their surgery, 97 percent said they would make the same decision again.

"The real question is, how did they feel in the long run?" said researcher Dr. Judy C. Boughey, breast surgeon and associate professor of surgery. "I want my patients to do what they will be happy with in 10 or 20 years."

Previous research found that women who had undergone prophylactic double mastectomy were satisfied with their decision soon after the surgery. This new research shows that those who were "comfortable with that decision still are many years after," said Boughey.

The findings were to be presented Friday at the annual meeting of the American Society of Breast Surgeons in Washington, D.C. Research presented at meetings is considered preliminary until it is published in a peer-reviewed journal.

With today's improved breast reconstruction techniques, women are likely "to be even happier with the results" than they were in decades past, noted Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, who is familiar with the findings.

Breast cancer affects about one in eight U.S. women, according to the National Cancer Institute. Nearly 90 percent will survive five years or more, according to the agency.

Surgical treatments include lumpectomy (excision of the tumor and surrounding tissue), mastectomy (removal of the diseased breast) or double mastectomy (removal of both breasts). A prophylactic double mastectomy does not guarantee that the cancer will not recur.

Adjunct treatment may include radiation, chemotherapy or hormone therapy, said Boughey.

For the study, women who had a cancerous breast and a healthy breast removed between 1960 and 1993 were asked 10 years later if they were satisfied with their choice. They were also asked if they would make the same decision again.

After another 10 years, the majority were surveyed once more. Complete results were available for 269 women.

In the initial survey, 86 percent said they were satisfied with their decision and 95 percent said they would repeat the procedure if they had to again. In the 20-year follow-up, 90 percent expressed satisfaction with their decision and 97 percent said they would repeat it.

However, about 30 percent in both time periods said they had suffered from negative body image, and nearly a quarter said their sense of femininity and sexual relationships were affected. Those effects did not increase with time, the results showed.

Experts say the prospects for women who undergo mastectomy today are much improved from 20 years ago. "We have procedures now that they didn't even have when the women in this study had their surgeries," Bernik said.

For instance, breast reconstruction now often accompanies the cancer surgery. The important thing is for women to come to terms with the decision, said Bernik.

"We don't push it [double mastectomy]," she said. Often, a young woman will have children, nurse them, and then decide to have the second breast removed, she noted.

According to Bernik, about 10 percent of breast cancers are caused by genetic mutations, and women who have family members already diagnosed with breast cancer are at higher risk if the cancer is genetically influenced.

Other risk factors for breast cancer are age or long exposure to estrogen, which occurs when menstruation begins at an early age and continues past 50, said Boughey. Women who give birth to a first child later in life are also at higher risk, she noted. Men can also develop breast cancer, but it is uncommon.

Breast cancer patients are doing better these days than even five or 10 years ago, said Boughey.

More information

To learn more about preventive mastectomy, visit the U.S. National Cancer Institute.

SOURCES: Judy C. Boughey, M.D., breast surgeon and associate professor of surgery, Mayo Clinic, Rochester, Minn.; Stephanie Bernik, M.D., chief of surgical oncology, Lenox Hill Hospital, New York City; American Society of Breast Surgeons, annual meeting, Washington, D.C., April 29, 2011

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