Nationally, a growing number of women with cancer in one breast are choosing to have both breasts removed as a way to prevent cancer in the other breast.
One of the best known examples of this trend is TV star Christina Applegate, who was diagnosed with breast cancer in 2008 and opted to remove her healthy breast along with the affected one. Applegate, who was treated elsewhere, has a family history of breast cancer and tested positive for mutations in the BRCA gene, both of which significantly increase her chances of eventually developing cancer in her healthy breast.
Ohio State researchers undertook this study to confirm this trend and to identify differences between women who chose a single, or unilateral, mastectomy compared with those who choose to also have the healthy breast removed, a procedure called a contralateral prophylactic mastectomy, said lead author Dr. Doreen M. Agnese, a surgical oncologist at OSUCCC-James whose research interests include breast cancer and clinical cancer genetics.
Between 1998 and 2007, Agnese and her colleagues identified a total of 1,639 women with breast cancer who selected unilateral mastectomy, and 201 women who selected contralateral prophylactic mastectomy to treat unilateral breast cancer at OSUCCC-James. An increasing trend in removing both breasts was observed, with 16.1 percent of women choosing this option in 2007 compared to 6.5 percent in 1999.
The findings were reported in a recent issue of the Annals of Surgical Oncology.
“Our experience parallels the national trend of the increasing use of contralateral prophylactic mastectomy in women diagnosed with unilateral breast cancer,” Agnese says. “Women who chose to have this preventive procedure were younger, more highly educated and more likely to have a family history of cancer.”
Investigators are trying to learn why more women are choosing this option. Previous research has shown that removing a healthy breast is unlikely to affect survival because tumors in the second breast tend to be detected at an earlier stage than those in the first breast, Agnese says.
Women with a family history of cancer were more likely to choose removal of both breasts rather than just the affected one (57.5 percent vs. 41.7 percent), particularly among women whose mothers or sisters had breast cancer, as did women with early-stage disease (stage 0, 1 or 2) compared with those with later-stage disease (stage III or stage IV).
“The level of education of these women seemed to greatly influence their decisions,” Agnese says. “Larger proportions of more highly educated women – those with at least some college education – selected contralateral prophylactic mastectomies compared to women with educational levels ranging from high school to vocational/technical school.”
Other Ohio State researchers involved in this study include Dr. Natalie G. Jones, John Wilson, Linda Kotur, Julie Stephens and Dr. William B. Farrar.
The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top 20 cancer hospitals in the nation, The James (www.jamesline.com) is the 180-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC-James is one of only seven funded programs in the country approved by the NCI to conduct both Phase I and Phase II clinical trials.
Medical Center Communications