A nurse performs a mammogram.

A large new study of California women diagnosed with early-stage breast cancer has found that those choosing to have both breasts removed survived no longer than those choosing more conservative treatments. The findings, published this week in the Journal of the American Medical Association, come as increasing numbers of American women undergo double mastectomies. We discuss the report and its implications for breast cancer education, treatment and prevention.

Guests:
Allison Kurian, assistant professor of medicine and of health research and policy at Stanford University Medical Center and lead author of the new double mastectomy study
Scarlett Lin Gomez, research scientist at the Cancer Prevention Institute of California and senior author of the mastectomy study
Karuna Jaggar, executive director of Breast Cancer Action, an education and advocacy organization for women living with and at risk for breast cancer
Michael Alvarado, associate professor of clinical surgery at UCSF and director of UCSF's Breast Surgery Oncology Fellowship

  • thucy

    We have known since the 90’s that double mastectomies don’t confer greater survival, so let’s ask ourselves: “Why are the rates of double mastectomies INCREASING?”

    Is it a coincidence that as women become more physically active (post Title IX) the rate of double mastectomies has increased? Has anyone noticed that it is the higher income women under 40 who are opting for double mastectomy? That’s the same population that had access to more rigorous athletic training and participation.

    If the double mastectomy buys an individual woman some time before having to move on to other procedures that she may perceive as less than optimal (radiation, chemo), then we should not assume that having the same survival rate without breasts was somehow less than optimal to her.

    Women can and should define their own individual feminine identity, especially when they are at the age when breast cancer is more common. Wealthier, more independent, and more physically confident women may not feel that their identity is wrapped up in their breasts.

    • Mrs. Eccentric

      “Wealthier, more independent, and more physically confident women may not feel that their identity is wrapped up in their breasts.”

      thucy, i think you’re assuming a lot there in your statement, and going a long way on those assumptions. I’m just glad to get some studies done addressing these issues, instead of people having to go on ‘feel. It’s just as possible that wealthier women are able to contemplate costly procedures which require longer recuperation periods away from work. Whatever your own view about female breasts may be, a double mastectomy is a really big procedure – one attraction of the lumpectomy is that it is much less traumatic on the body. One would think less trauma would enable the body more prepared to fight the cancer as well as to undergo the rigors of chemo and radiation.

  • sstanley

    In the mid 70’s my 44 yr. old mother was diagnosed with breast cancer. There weren’t a lot of options and she had a single mastectomy and a year later decided to have her other breast removed. She lived to be 81 and whether this decision made that possible we’ll never know. Does a “peace of mind” factor into this at all?

    • Mrs. Eccentric

      sstanley, that is a good point. Would her peace of mind have been affected by having access to the results of this study, or even more data?

      Double mastectomy is a big operation, a certain number of people die just from general anaesthesia, plus there’s always risk of other complications which also can be fatal. That’s why i think these studies are so important – you can get the peace of mind without taking on some pretty significant risks.

  • Tina Clarke Dur

    Question for Drs. Alvarado and Kurian: it sounds like some women rush into thinking they have to have a double mastectomy immediately after a diagnosis. What kind of options do women have for waiting and learning more about their cancer before they make a treatment decision?

  • Leana NĂ¡poles

    @KQEDForum can u talk a little bit about access to care issues with undocumented women & patient navigation systems before & after surgery? Thank you!

  • Kristin Crosland

    I am stage 4 breast cancer fighter currently in remission. I had no lumpectomy option given tumor size and had single mastectomy and chemo and radiation. Wondering about profolactic second mastectomy for stage 4 women like me

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