31 Days of “Little Known” FACTS — For Breast Cancer Awareness Month — Day 23 — Double Mastectomies for DCIS?

Did you know…

“Many women who have DCIS are choosing not to just to get a mastectomy, but to get a bilateral mastectomy and have both breasts removed.” – Otis Brawley, NPR

“More women with ductal carcinoma in situ (DCIS) are choosing to add contralateral prophylactic mastectomy to their treatment, despite the paucity of evidence that it prolongs life. Since we published our studies, we have received more than 100 e-mails from patients telling us why they chose to undergo bilateral mastectomies when they only had disease in one breast.

A lot of them fear cancer.

A lot of them think that if they have bilateral mastectomies, that they’re going to eliminate the chance of ever getting cancer again, which, unfortunately, is not necessarily true.” – Big Increase In Use of Prophylactic Mastectomy for DCIS

Use of prophylactic mastectomy in the treatment of DCIS has steadily increased as it has for invasive cancer. – The mastectomy rate for DCIS is increasing in an equal-access healthcare system

“There is a low risk of contralateral breast cancer after DCIS for women treated with breast conserving surgery and this risk is low irrespective of age, family history, and characteristics of initial DCIS,” said Megan Miller, MD, of Memorial Sloan Kettering Cancer Center in New York. According to Miller, overall survival after treatment for DCIS is excellent, yet many patients overestimate both their risk of local recurrence and their risk for contralateral breast cancer, potentially leading to decisions in favor of bilateral mastectomy.Bilateral Mastectomy in DCIS May Be Overtreatment

“There is no data to support bilateral mastectomy. Doing more surgery does not in fact give patients better outcomes.” – Dr. Susan Love, SABCS 2015: Comparing Lumpectomy vs. Mastectomy: Survival, Complications and Cost, Breast Cancer Action

Why Are So Many American Women Having Mastectomies?

“For many years, experts have known that women who undergo mastectomies for the non-invasive condition called ductal carcinoma in situ (DCIS) or for early-stage breast cancer do not live longer than women undergoing lumpectomies. However, the latest research goes a step further:  A 2016 study of more than 37,000 women with early-stage breast cancer found that the women undergoing lumpectomies were more likely to be alive 10 years later than women with the same diagnosis who underwent a single or bilateral (double) mastectomy. They were also less likely to have died of breast cancer. In 2016, Harvard cancer surgeon Dr. Mehra Golshan reported that of almost half a million women with breast cancer in one breast, those undergoing double mastectomies did not live longer than women undergoing a mastectomy in only one breast. These are just the latest studies – for more information about the years of consistent evidence that less radical surgery is better, see this article.

And yet, an increasing number of U.S. women with early-stage breast cancer are choosing to have both their breasts removed “just to be safe.”

A 2015 study conducted by researchers at Vanderbilt University reported that, for women diagnosed with early-stage breast cancer in one breast, the rates of double mastectomy increased from 2% to 11% from 1998 to 2011. Researchers found that decisions to have a double mastectomy increased more for two groups of women: 1) Women with ductal carcinoma in situ (DCIS) where there are abnormal cells inside a milk duct in the breast that won’t spread and aren’t dangerous unless breast cancer develops later; and 2) Women with cancer only in one breast that has not spread to the lymph nodes. This year (2017), researchers from Emory University reported that the percentage of women over 45 getting double mastectomies for early-stage breast cancer in one breast increased from 4% to 10% in less than a decade. For women ages 20-44, the percentage tripled from 11% to 33%. To some extent, geography was destiny: in five Midwestern states (Nebraska, Missouri, Colorado, Iowa, and South Dakota), 42% of the women who got surgery had a double mastectomy.

The bottom line is that women with DCIS or early-stage breast cancer have more effective and less radical treatment options than mastectomy. Even women with BRCA1 or BRCA2 may never develop breast cancer, and if they do, they may not need a mastectomy. We need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice. Each woman should make the decision that is best for her, based on information, not on fear.”

About Donna Pinto

I am originally from New Jersey and moved to Los Angeles with my family at age 12. After graduating from San Diego State University with a BA in Journalism, I had a short-stint in magazine advertising sales before landing my "dream job" with Club Med. For two years I worked at resorts in Mexico, The Bahamas, The Dominican Republic and Colorado. My husband Glenn & I met in Ixtapa, Mexico and we embarked on a two year honeymoon around the world. This was also a research project for a book we wrote called "When The Travel Bug Bites: Creative Ways to Earn, Save and Stay Abroad." I am also the author of a quote book for new graduates -- "Cheatnotes on Life: Lessons From The Classroom of Life." In 1997, we settled in San Diego and I was blessed to work part-time from home for non-profit organizations while raising our two boys. In 2010, a DCIS diagnosis changed my life. DCIS 411 is the culmination of my on-going journey and discoveries.
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