Evidence Doesn't Support Double Mastectomy Trend


Are women with early-stage unilateral breast cancer misinformed about the survival benefit of removing both breasts vs lumpectomy with radiation?

When diagnosed with early-stage breast cancer, more women are opting to have bilateral mastectomies, despite little evidence that the procedure will keep them alive for longer, a large California study found.

Pertinent Points

- Double mastectomies in early-stage breast cancer don’t yield better survival rates.

- When faced with early-stage breast cancer, the number of women opting to have both breasts removed is increasing.

- The survival rates between double mastectomies and breast-conserving surgery with radiation are similar.

The study, which included 189,734 women and was published earlier this month in JAMA, found no survival benefit for women with early-stage breast cancer who have had both breasts surgically removed compared with women who select breast-conserving surgery with radiation.

Women who had a double mastectomy had an 81.2% survival rate at 10 years, compared with 83.2% for those undergoing lumpectomy. The same was not true for women having a single mastectomy. For those women, the 10-year survival rate fell to 79.9%, but this option saw decreasing popularity over the years, with women of all age groups less likely to select that treatment option.

Still, the number of women who had double mastectomies increased from 2% in 1998 to 12.3% in 2011, with the trend most pronounced among women younger than 40. By 2011, 33% of the women younger than 40 were choosing bilateral mastectomy, even though most of them had stage 0 or 1 cancer. That was up from just 4% of women making the same decision in 1998.

"In a time of increasing concern about overtreatment, the risk-benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient's preference for a morbid, costly intervention of dubious effectiveness," the authors wrote in suggesting the results could help inform patients and physicians about the surgical treatments of breast cancer.

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