Receiving a diagnosis of breast cancer is devastating. It affects every part of your life and leaves you making decision you never thought you would have to make.
Lately, many women are choosing to have a double mastectomy in order to preserve their health and decrease their chances of having a recurrence in the future. This is becoming known as the “Angelina Jolie effect” however new research published in JAMA has reported contrary information.
Researchers studied 190,000 women in the state of California between the years of 1998-2011 who had stage 0-III breast cancer in only one breast. The goal was to determine how different treatment options affect mortality rates. The researchers looked at one-sided mastectomy, bilateral mastectomy, and other conservative surgery with radiation.
The results were quite interesting in that there was not that much of a difference in mortality rates. This means that women who chose to remove just the affected breast, both breasts or keep their breasts and do a lumpectomy and radiation, had the same mortality rate.
Fear is the biggest driving factor, understandably. However, researchers noted that currently in California, about one-third of women under 40 years old are choosing a double mastectomy, even when they do not have aggressive breast cancer such as those with the BRCA gene.
A double mastectomy is a major surgery that requires a lot of recovery time, plus additional surgeries for reconstruction if that is desired.
One-sided mastectomy is not without issues as those women (if they choose) will also undergo reconstruction on the affected side.
A lumpectomy is not as invasive as a mastectomy, however radiation does require a significant time commitment -- sometimes several days per week for six weeks.
Due to the influential effect of Angelina Jolie, many women are running to their doctor and asking for the genetic test for breast cancer, commonly known as the BRCA gene. While rare, those who have the mutation are more likely to have breast and/or ovarian cancer.
Testing is quite expensive. However it is generally considered acceptable to test for this gene:
- If a woman has a prior history of breast or ovarian cancer
- If she has a first-degree blood relative who has breast or ovarian cancer
- If she has a blood relative who has tested positive for the mutation
- If she is of Ashkenazi Jewish descent
If you are currently debating as to whether or not you should have a mastectomy, or if you feel you are at higher risk for the BRCA gene mutation, talk with your health care provider about this new information. See how it applies to you and your long term health.
Sources:
Chustecka, Z. (2014). ‘Angelina Jolie Effect’: BRCA Testing Doubles. Retrieved from
http://www.medscape.com/viewarticle/831010#1
Kurian, A., Lichtensztajn, D., Keegan, T., Nelson, D., Clarke, C., and Gomez, S. Use of and Mortality after Bilateral Mastectomy Compared with Other Surgical Treatments for Breast Cancer in California, 1998-2011. JAMA. 2014;312(9):902-914.
http://jama.jamanetwork.com/article.aspx?articleid=1900512
Lowry, F. (2014). No Survival Benefit for Increasingly Used Bilateral Mastectomy. Retrieved from
http://www.medscape.com/viewarticle/830947
Reviewed September 10, 2014
by Michele Blacksberg RN
Edited by Jody Smith