Date:
10/22/2007 07:01 PM More women getting both breasts removed when cancer
strikes one
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ Removing just her cancer,
not her whole breast, at first sounded like a good option
to Trisha Stotler Meyer. Then two years later, a cyst in her
healthy breast sparked terrifying new checkups.
"It was at that moment that my breasts
became like tonsils," is how Meyer, 37, puts it. "I
don't need them anymore. They're gone."
She's not alone. More women who have cancer
in only one breast are getting both breasts removed, says
research that found the trend more than doubled in just six
years.
It's still a rare option: Most breast cancer
in this country is treated by lumpectomy, removing just the
tumor while saving the breast.
But the new study suggests 4.5 percent of
breast cancer surgery in 2003 involved women getting cancerous
and healthy breasts simultaneously removed, a 150 percent
increase from 1998 — with no sign that the trend was
slowing.
Young women are most likely to choose the
aggressive operation, researchers report Monday in the Journal
of Clinical Oncology.
The concern is whether they're choosing in
the heat of the moment — breast cancer surgery often
is within two weeks of diagnosis — or with good understanding
of the pros and cons.
"Are these realistic decisions or not?"
asks Dr. Todd Tuttle, cancer surgery chief at the University
of Minnesota, who led the study after more women sought the
option in his own hospital.
"I'm afraid that women believe having
their opposite breast removed is somehow going to improve
their breast cancer survival. In fact, it probably will not
affect their survival," he said.
But removing the remaining healthy breast
does greatly lower, although not eliminate, chances of a new
cancer developing on the opposite side.
Don't underestimate the peace of mind that
brings, said Meyer, of Vienna, Va.
"Doctors are not up at night crying"
in fear of their next mammogram, she said. "I don't want
to have to deal with the stress."
Meyer was diagnosed with cancer in January
2005, shortly after her son's birth. She had a lumpectomy,
followed by chemotherapy and radiation.
But she didn't qualify for anti-hormone drugs
that protect many women against cancer in the remaining breast.
And in March — after finding a lump that turned out
to be a cyst that waxed and waned — she started considering
a return to the operating room. Three weeks ago, she had both
breasts removed.
In a single day last week, Dr. Shawna Willey
of Georgetown University's Lombardi Cancer Center had two
patients seek that same operation.
One needed her entire cancerous breast removed,
and immediately asked to have the healthy one removed, too.
Another woman had recently undergone a lumpectomy and was
sick from chemotherapy — and returned to ask that both
breasts be fully removed.
"Her perception is, 'If I have my breasts
taken off, I never have to do this again,'" said Willey,
who asked the woman to see a counselor and finish chemo before
deciding.
"I can understand that point of view,"
she added. "But I always tell them, it's not a guarantee."
The American Cancer Society estimates 178,480
U.S. women will be diagnosed with breast cancer this year.
About 40,460 will die of it.
Some women at high risk, because of notorious
breast cancer genes or family history, choose preventive mastectomies
before cancer ever strikes.
Tuttle's study is the first national look
at how many women choose to remove both a diseased and healthy
breast together.
He used a government cancer registry that
covers 16 regions, a representative sample of the U.S. population,
to track more than 150,000 breast cancer surgeries between
1998 and 2003.
Tuttle calculated that lumpectomies accounted
for almost 60 percent of those surgeries in 2003. Lumpectomies
have gradually increased since they were proven just as effective
as breast removal for early cancer in 1991.
The surprise: Single mastectomies remain the
No. 2 option but are dropping — while double mastectomies,
although uncommon, were on the rise for every stage of cancer.
Even women who qualify for anti-hormone drugs to protect the
remaining breast were as likely to choose removal as women
with harder-to-treat tumors.
Why? Tuttle is planning a new study to tell,
and to see if candidates are warned about such risks as infection
that increase with the bigger surgery.
Georgetown's Willey says better reconstructive
surgery is partly spurring the trend. Still, she often encourages
women to wait to remove the second breast, as lining up reconstruction
sometimes dangerously delays treating the cancer.
"When I was younger ... I really tried
to argue with patients and talk them out of it," Willey
said. Now, if they've weighed the options, she doesn't.
"I can't recall a single patient who
tells me they regret that decision."
———
On the Net:
American Society of Clinical Oncology consumer
info: http://www.plwc.org/CancerAdvances
