More women getting mastectomies they may not need

When confronted with early stage breast cancer, surgical removal of the tumor alone (lumpectomy) -- which conserves the breast -- can be a less drastic option than total mastectomy.

However, a new study shows that a rising number of early stage breast cancer patients who are eligible for lumpectomy are nonetheless undergoing mastectomy.

Researchers led by Dr. Kristy Kummerow, of Vanderbilt University Medical Center in Nashville, tracked data from the National Cancer Data Base. They found that the percentage of early stage breast cancer patients who were eligible for breast conservation surgery but underwent mastectomy rose from just over 34 percent in 1998 to nearly 38 percent in 2011.

The largest increases were among patients with lymph node-negative, contained cancers -- tumors that did not show evidence of spreading, according to the study published online Nov. 19 in the journal JAMA Surgery.

One expert believes there may be many reasons driving the trend.

"While we have known for quite a long time now that survival from breast cancer is equivalent comparing lumpectomy with mastectomy, there are clearly other forces -- such as aesthetics, genetics and anxiety related to future screening -- that are also driving surgical decision-making, especially for younger women with breast cancer," said Dr. Elisa Port, chief of breast surgery and co-director of the Dubin Breast Center at The Tisch Cancer Institute in New York City. She was not involved in the new research.

Kummerow's team found that younger women were more likely to have a mastectomy regardless of tumor size, while older women were more likely to undergo mastectomy if they had a tumor larger than 2 centimeters.

Rates of double mastectomy when cancer had only been detected in one breast also rose -- from just under 2 percent in 1998 to just over 11 percent in 2011, and rates of double mastectomy for early stage cancer in one breast increased from 5.4 percent of mastectomies in 1998 to nearly 30 percent in 2011, the researchers said.

Another outside expert believes that a woman's decision to undergo full mastectomy may often be a reasonable one, however.

"One of the reasons for the increased mastectomy rate may be because the [breast] reconstruction options over the past two decades have continued to improve and there is greater awareness that reconstruction is covered by insurance," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City. "A mastectomy is not the dreaded procedure that it was 20 years ago."

The new study found that rates of breast reconstruction among women undergoing mastectomy rose from about 12 percent in 1998 to just over 36 percent in 2011, while rates of breast reconstruction among women who had a double mastectomy for early stage cancer in one breast increased from nearly 37 percent to just over 57 percent.

Bernik believes that the "reasons for the trend [towards more mastectomies] need to be investigated, as we need to make sure that women are making sound choices. However, one cannot assume that just because a woman chooses a mastectomy for an early stage cancer, she is doing so for the wrong reasons."

According to Bernik, "a woman's choice to undergo a mastectomy with or without reconstruction is a legitimate one, as long as she is fully informed of the pros and cons of breast conservation versus removal of the breast."

But two other experts believe the new data puts current breast cancer treatment guidelines into question.

"Existing guidelines are in place to ensure that patients are offered the appropriate options," Dr. Bonnie Sun and Dr. Michael Zenilman, of Johns Hopkins Medicine, wrote in an accompanying editorial. The new study should "serve as a wake-up call that as we fulfill that responsibility, and use every [method] of care to give patients the best quality of life and survival advantage, the guidelines may need to change again."