Double Mastectomies: Who Is It Right For?

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Topics include: Treatment

When a woman is diagnosed with breast cancer, it can be terrifying. Concerns begin to arise, such as how do you treat the cancer and what surgical approach is right for you? Dr. Kristine Calhoun, a dedicated breast specialist and associate director of the Breast Health Center at the Seattle Cancer Care Alliance, joined Patient Power to discuss the controversy surrounding double mastectomy and the important factors to consider when choosing what treatment is best for your specific situation.

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Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Hello and welcome to Patient Power.  This program is sponsored by the Seattle Cancer Care Alliance.  I'm Andrew Schorr. 

Well, certainly a diagnosis of breast cancer is terrifying. Joining us to help us understand the latest thinking about options for women is Dr. Kristine Calhoun. She is a breast specialist and a breast surgeon at the Seattle Cancer Care Alliance.  Dr. Calhoun, welcome back to Patient Power. 

Thank you so much for having me. 

So, Dr. Calhoun, I'm sure there are many women who come to you at various stages of breast cancer in one breast, and they say are thinking about having a double mastectomy. How do you handle that conversation with them?

So it is something that we are definitely seeing much more frequently.  I've been here at the SCCA and at the UW since 2005.  I believe studies show that in that time period about 150 percent increase in the number of women requesting the bilateral mastectomies for cancer treatment on the one side and for prevention on the other side. 

It's definitely an individualized discussion that we have with each patient, and I can tell you that our SCCA experience definitely mirrors what we're seeing in the nation in terms of our rates have also increased. 

So there had been studies that maybe recommended double mastectomy, but what do the latest studies show? 

So the studies are I think you can always find a study that helps support your opinion.  The more recent studies that have come out have definitely questioned whether or not there is a survival advantage or benefit from doing the bilateral mastectomies.  A couple of years, there were some studies which actually did say that doing the prophylactic mastectomy on the noncancer side would actually improve the survival of a patient.  But I think the more recent studies have actually shown that no, rates of survival are equivalent for patients who do the bilateral mastectomies or for those who either do a unilateral mastectomy, meaning on the cancer side, or instead do a lumpectomy for treatment of their cancer.

Dr. Calhoun, so lumpectomy has been available for many years, and I know you are a big believer in breast conservation.  And certainly women don't want to have more surgery than they need if they can be confident that they can take care of the breast cancer. You would agree with that?

That is correct.  I think that we have well over 25 years of data in this country.  The Europeans actually led the curve in terms of proving that for the appropriately selected patient a lumpectomy is accurate and adequate treatment. 

If a patient does have the option of a lumpectomy, I tell her what the potential risk is.  We do know that local recurrence risk or the possibility that the cancer could recur in that breast is 10 percent or less for a patient who chooses to do the mastectomy. 

A lot of patients will say, my cancer can't come back if I do the mastectomy. And we need to educate them as providers that that's not accurate, that there is what we call a local recurrence risk or a chest wall recurrence risk even for a patient who chooses a mastectomy.  That risk is generally felt to be 5 percent or less. 

But the survival rate, we now know, and have known for a while and are trying to advocate and get this message out, survival rates are the same whether you do a mastectomy or whether you do the lumpectomy with the radiation.  

So the takeaway message is to have a conversation with your doctor to make sure you understand the options and have a frank discussion of what you feel comfortable with. Dr. Kristine Calhoun, breast surgeon and breast specialist at the Seattle Cancer Care Alliance, thanks for being with us on Patient Power.

Thank you so much.

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Page last updated on January 19, 2015