I am frequently asked this question: “I am a young woman diagnosed with breast cancer. I want both breasts removed because my mother had cancer so why is my surgeon recommending a lumpectomy?” We see many women requesting mastectomies on both breasts to decrease their cancer risk. Angelina Jolie is the most recent highly publicized case for bilateral mastectomies.
In the past, data suggested that survival is no different in breast cancer patients treated with either lumpectomy and radiation or mastectomy. This is the information most surgeons offer to breast cancer patients. But the risk of local recurrent cancer is higher after lumpectomy and radiation compared to mastectomy alone.
Recent observations suggest women under the age of 40 want to decrease their risk of recurrence as well as seeking a cure of their breast cancer. Increasing numbers of young women are requesting mastectomies for treatment of their cancer and in particular bilateral mastectomies. One study indicates that breast cancer is up 100% over two years and another study shows a 200% increase over 8 years. For young women with breast cancer, removing both breasts is seen as a viable cancer preventing option.
Most women are aware that breast cancer tends to be more aggressive in younger women. Almost everyone knows of a family that has been devastated after the loss of a young mother who had metastatic breast cancer. A recent article in the Journal of the American Medical Association (JAMA February 2013) confirmed that young women tend to have more aggressive breast cancers. This article shows the incidence of advanced incurable metastatic breast cancer in women aged 25 to 39 rose over 200% over the last 20 years! This is evident despite an overall decrease in breast cancer deaths and a stable incidence of breast cancer in the female population over those years.
These women are young mothers, wives, and family members. One 32 year old mother told me: “I have three young children and I want to do whatever I need to do to be around for them as long as possible.” I have always recommended that my patients do whatever they can now so they are not second guessing themselves if they have a recurrence in 10 years. Often that means choosing a mastectomy or even bilateral mastectomies. These feelings need to be discussed with the surgeon treating the cancer especially in light of recent evidence.
Thomas J. Francel, MD