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Mastectomies Up for Early Breast Cancer

Women Increasingly Choose Breast Removal Over Breast-Conserving Surgery
By
WebMD Health News
Reviewed by Louise Chang, MD

May 16, 2008 -- More women with early-stage breast cancer are opting to have a mastectomy, a new study suggests.

Breast-conserving surgery, in which only the tumor and surrounding breast tissue are cut out, has been the treatment of choice for most women with early-stage disease since 1990. That's when a National Institutes of Health Consensus Panel reported that it is as effective at saving lives as the more disfiguring mastectomy, in which the entire breast is removed.

But recently, the number of mastectomies performed at the Mayo Clinic in Rochester, Minn., shot up 13% in just three years.

Mastectomy accounted for 43% of early-stage breast cancer surgeries in 2006, compared with 30% in 2003, says researcher Matthew Goetz, MD, a breast cancer specialist at the Mayo Clinic.

"The mastectomy rate in 2006 was about the same we saw in the late '90s," he tells WebMD.

Other studies have also documented an increase in mastectomy rates in the U.S., says Julie Gralow, MD. She is chairwoman of the cancer communications committee of the American Society of Clinical Oncology (ASCO) and associate professor of medicine at the University of Washington in Seattle.

For example, women who undergo a mastectomy for cancer in one breast are increasingly choosing to have their other, healthy breast removed as a preventive measure, Gralow tells WebMD.

The new study involved 5,464 women who had surgery for early-stage breast cancer at the Mayo Clinic between 1997 and 2006. It is scheduled to be presented here at ASCO's annual meeting.

Why Mastectomy Rates Are on the Rise

One reason why more women are choosing mastectomy, the study suggests, is the increased use of breast magnetic resonance imaging (MRI) scans before surgery. MRIs can spot tiny lesions throughout the breast that couldn't be seen on earlier tests.

The problem: Such lesions may or may not be cancerous, Gralow says. "If the MRI actually finds cancer, more aggressive surgery is appropriate. But it would be a tragedy to choose mastectomy if the MRI was just spotting tiny specks, little benign things."

Plus, the increased use of MRI couldn't account for the entire rise in mastectomy rates in the study; they also shot up among women who didn't have the scans.

Gralow says better breast reconstructive techniques are another reason why more women are opting for the procedure. Thanks to new surgical techniques, mastectomy with breast reconstruction often results in at least as good cosmetic and functional outcomes as breast-conservation surgery, she says.

Also, studies have shown that while the chance of survival is the same after both procedures, mastectomy is associated with a lower risk of developing a new cancer in the affected breast: 2% vs. 10% for breast-conserving surgery, Gralow says.

Other women may wish to avoid radiation therapy, which is an integral part of breast-conserving treatment, she says. It's given after the surgery to kill any remaining cancer cells.

"There's often no right or wrong answer," Gralow says. "Women need to sit down with their doctors and discuss all the options."

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