Women with breast cancer should examine their treatment options

BY BEATRIZ E. AMENDOLA

The number of women having double, or bilateral, mastectomies in this country is on the rise.

When facing breast cancer, deciding which type of surgery to select for early-stage disease is not easy.

However, the choice is not between saving your breast and saving your life.

Women with early-stage breast cancer who have breast-conserving surgery (lumpectomy) live just as long as those who have a mastectomy. Survival is the same no matter the surgical choice.

If breast cancer is diagnosed early and there are no genetic factors that can change the course of the disease, we can reach 95-percent cure rates with appropriate, conservative treatment.

So why are we seeing so many patients go for a mutilating procedure, with chances of severe complications?

Could it be vanity and the enticement of getting a tummy-tuck and a breast augmentation at the same time? Advances in plastic surgery promise more attractive artificial breasts than years ago.

Unfortunately many women do not think about the consequences of such a drastic approach.

Breast cancer is not a local disease — it is systemic, and that is one of the reasons that we need to use some form of systemic hormones or chemotherapy to avoid mastectomies.

For a small number of women, bilateral mastectomies are necessary because of cancer in both breasts or because they have an aggressive type of cancer.

However, most double mastectomies are done on the breast with cancer, and a prophylactic mastectomy of the healthy breast.

There are many scenarios in which the decision to proceed with bilateral mastectomies is based upon unfounded fear or an inaccurate assessment of the risks and benefits a woman may face.

Clearly a major factor is “the Angelina Jolie effect.”

She made her BRCA1 gene mutation public in 2013 when she detailed her path to a bilateral mastectomy after learning that this mutation carries an 87 percent risk for developing breast cancer.

However, the BRAC1/2 genes linked to breast cancer are rare (0.25 percent).

In the United States, only one in 800 women in the general population is affected by this mutation.

Current guidelines discourage bilateral mastectomies for most women and recommend it only be considered on a case-by-case basis for women at high risk of bilateral breast cancer.

These include women who carry a BRCA1 or BRCA2 mutation, or those who have a higher risk of contralateral breast cancer.

It’s important for women to always get a second opinion and discuss the options with specialists: surgeon and medical and/or radiation oncologist. Then they can make an educated decision.

It’s interesting that when shopping, women shop around, looking for a variety of choices, be it a new car or clothing.

Yet when dealing with breast cancer, most women see only one surgeon and, perhaps, a plastic surgeon without getting a second or even third opinion.

It also helps to talk to other women who have “been there” and can tell you of their own experiences.

There have been many advances in the field of radiation oncology for breast-cancer patients.

Brachytherapy is an alternative to conventional irradiation for early breast cancer.

Only part of the breast is treated and a shorter course (usually five to seven days) is used as opposed to conventional external radiation treatment that usually requires five weeks to six weeks of daily radiation treatments.

This treatment delivers radiation to the area where it is needed most with minimal radiation exposure to the adjacent normal tissues reducing the potential for side effects.

The decision to have bilateral mastectomies should not be made without considerable thought and research.

In my view, women should proceed cautiously and think carefully about the advantages and disadvantages of all the medical choices involved so they can lead a happy and healthy life post cancer.