More surgery not always the answer for breast cancer

New report shows increase in mastectomy despite steady rate of breast cancer diagnosis

February 22, 2016

Although breast cancer rates have remained constant between 2005 and 2013, the overall rate of mastectomies increased by 36 percent, according to a report released this month from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

UC Irvine Health surgical oncologist Dr. Alice Police believes this increase is due to mistaken patient perception that mastectomy has a lower rate of cancer recurrence, and that is a problem.

“Patients need to know that with breast cancer, more surgery is usually not the answer,” she says. “They think that surgery alone will cure breast cancer, but that is usually not the case.”

Study shows increase in surgery

The AHRQ report found that between 2005 and 2013:

  • Overall, the rate of mastectomies increased from 66 women per 100,000 to 90 per 100,000
  • The rate of double mastectomies more than tripled, from nine out of 100,000 women to 30 out of 100,000
  • One third of all mastectomies in 2013 were double mastectomies
  • The rate of women without cancer getting preventative double mastectomies increased from two per 100,000 women to four per 100,000

In some cases, Police says, a mastectomy is required. Those cases involve patients with certain genetic mutations, or bilateral cancer — in both breasts at the same time, or a very large cancer.

Mastectomy can be detrimental

According to Police, the average breast cancer patient in the US is a post-menopausal woman diagnosed with Stage 1 or Stage 2 unifocal cancer — located in one breast. Choosing to undergo a mastectomy can be detrimental to the patient, because life-saving therapies like radiation or chemotherapy may be delayed or omitted.

“Every patient is different and there is a best choice for each one,” she says. “We take a very personalized approach to treatment, but usually, the highest chance for long-term, disease-free survival is for the patient to undergo lumpectomy and radiation. Only about one-third of patients need chemotherapy.”

Reversing the trend

The trend of an increasing mastectomy rate is new to the general public, but is an issue of concern for the American Society of Breast Surgeons and has been a topic of discussion at academic conferences and other professional meetings for the past few years.

“It is important for both physicians and patients to be aware that lumpectomy plus radiation equals a better overall cure rate in most cases,” Police says. “Radiation instead of mastectomy is safer and complications are much lower.”

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