Mastectomy: Radical or sensible?

May 25, 2013 10:53:51 PM

Carmen K. Sisson - [email protected]


When actress Angelina Jolie recently revealed she had undergone a preventative double mastectomy, it was a very personal decision that sparked a very public debate. 


Jolie, 37, explained her decision in an opinion piece in the New York Times, saying it was a proactive choice she made after learning that she carries a genetic mutation that gives her an 87 percent risk of developing breast cancer and a 50 percent chance of developing ovarian cancer. Her mother died of ovarian cancer in 2007. She was 56.  


The decision caused a spate of arguments for and against the procedure, also known as a preventative bilateral prophylactic mastectomy. Proponents say it can reduce the risk of hereditary breast cancer by as much as 97 percent. And many cancer experts and Jolie supporters applauded her decision, calling her brave, courageous and even a hero.  


But critics came out in full force as well, saying they fear Jolie's role as a public figure may lead more women to follow through with what they feel is a radical procedure. Though genetic mutations account for less than 10 percent of all breast cancers in the United States, statistics from Memorial Sloan-Kettering Cancer Center researchers in New York indicate preventative double mastectomies are sharply rising, with 30 percent of BRCA1-positive women going through with the procedure. 


Surgeons at M.D. Anderson Cancer Center in Houston are seeing the same increase, but general surgeon Dr. Michael Berry, of Columbus Surgery, says the trend seems to be slowing locally, especially as early screening and advances in treatment have led to fewer mortalities.  


"It used to be something people did," Berry says. "They would be scared to death, but (preventative mastectomy) is way overkill. It is very controversial, and I think (Jolie) really kind of confused people by going out and doing this." 


Berry is not alone in his view that only women with specific risk factors should consider genetic testing like that which led to Jolie's decision. 


Though the tests are relatively easy, involving little more than a cheek swab, they can cost as much as $3,000, and though some insurance companies will cover the cost, many will not.  


And there are other reasons a woman might want to reconsider having the test, Berry says. 


The test can be inconclusive, and a preventative double mastectomy still carries some risk that not all breast tissue will be removed. There are also risks in the surgery itself, he says, as well as emotional factors to consider.  


The American Cancer Society and the U.S. Preventative Services Task Force recommend that only women with a strong family history of breast cancer (two first-degree relatives or three or more first or second-degree relatives) consider genetic testing for BRCA mutations.  


But even if a woman is diagnosed with breast cancer, mastectomy is no longer the first line of treatment -- a fact which surprises many women, Berry says. Breast conservation surgeries -- a combination of lumpectomies and radiation -- are often recommended, but ultimately, surgeons will adhere to the patient's wishes, he says. 


Many women who are carriers of the mutation spoke out this week in favor of preventative double mastectomies though, saying peace of mind is worth any negatives they may incur. 


In the Huffington Post blog this week, writer Eva Moon details the terror of never knowing when --¬†or if -- the mutation will rear its head, especially if a close family member is currently being treated for breast cancer. While doctors recommend more frequent mammograms and other less invasive preventative measures, some feel it's not something they want to spend the rest of their life fearing every time they are tested. 


"So let me ask you," Moon writes, "How many times will you do this, knowing they'll find something every time? ... If you have a mastectomy now, it's done and paid for. If you have a mastectomy now, it's just a mastectomy. If you wait, it's a mastectomy, chemo, radiation and possibly death. The future is a vast unknown with a giant 'C' on it." 


Berry understands that sentiment. 


"Theres a personal fear of it that (carriers of the mutation) cannot handle," he says. "We try to ease their minds on that. (Preventative double mastectomy) is a very aggressive approach." 


Berry discourages women from flooding doctors' offices, asking for the test, especially if they do not have a strong family history of breast cancer. 


"She's probably going to have the best reconstruction," Berry said of Jolie. "That's not even real world, almost. We deal with real world people who come in already diagnosed with breast cancer."

Carmen K. Sisson is the former news editor at The Dispatch.