Docs push 'peace of mind' surgeries over survival

Double mastectomies gain favor as ratio of 1 in 8 U.S. women getting breast cancer remains the same

Women with cancer in a single breast are increasingly opting to remove both — prophylactically.

That's despite more treatment possibilities now being available and despite medical experts saying the double mastectomy doesn't necessarily lead to better outcomes.

Reporting by Alexandra Sifferlin in a Time magazine story cites a study of 5,080 women with early stage breast cancer published in JAMA Surgery to the effect that a 20% increase is being driven in part by the patients' surgeons. The study, which considered women who had an average risk for cancer in the second breast, also surveyed 377 of the patients' surgeons.

Although the doctors — who generally did recommend a double mastectomy for patients at high risk — initially leaned toward breast-conserving surgery for average-risk patients rather than CPM, or contralateral prophylactic mastectomy, they were apt to change their minds, the story says.

Why? 

"To give patients peace of mind" and to "avoid patient conflict" — rather than "to reduce recurrence or improve survival."

Women whose surgeons were among those most reluctant to perform a double mastectomy "had only a 4% chance" of having one, the study showed, while the likelihood of women whose doctors were most open to getting CPM having both breasts removed was 34%.

Dr. Steven Katz

Sifferlin's story quotes Dr. Steven Katz, prof at the School of Public Health at the University of Michigan, as saying, "The emotional reactions to cancer frequently prime patients to desire the most aggressive approach. Our results underscore that most surgeons today favor less aggressive approaches to surgery, and it's challenging for them to communicate with their patients that bigger is not better."

The Time article also says that Katz's earlier research "found that a woman's fear about cancer recurrence or her desire to avoid regret can also lead to a decision between her and her doctor to choose more aggressive surgery."

Katz suggests women should consider getting a second opinion, although 95% of breast-cancer patients are treated by the first physician they see.

In a companion Time story that acts as an introduction to Sifferlin's, Alice Park notes that "women now have more information about their disease — down to the very DNA of their tumors — than ever before, so they can make more informed decisions about how aggressively they want to be treated."

She further writes that "scientists also have an evolving understanding of how women can better endure treatment with fewer side effects — and they have plenty of options to do so, from getting more sleep to practicing yoga or eating healthfully."

In addition, Park contends, "women are becoming empowered to make better decisions, and research is even revealing what they should know about the potential biases of the doctors who treat them."

More information about choices of treatment can be obtained by reading "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.