What's Behind the Increase in Mastectomies in Women with Breast Cancer?

In early 2016, the US Department of Health and Human Services’ Agency for Healthcare Research and Quality released a report that shows women with breast cancer are choosing mastectomies (or double/’bilateral’ mastectomies) at much higher rates than they were a decade ago.

This rise in mastectomies has many wondering why—and whether mastectomy is, in fact, the best choice for patients.

Choosing a Breast Cancer Treatment Plan is Highly Personal

Ultimately, these numbers reveal a shift in patient choice. Each woman who receives a breast cancer diagnosis faces a variety of options before making a life-changing decision about how to proceed. Women are likely choosing mastectomy in greater numbers for a variety of personal reasons. Many breast surgeons have responded to this trend with concern, suggesting women might unnecessarily overlook lumpectomy in favor of a more aggressive approach.

One thing’s for sure: lumpectomy (a surgery where just the tumor, and sometimes lymph nodes, are removed) plus radiation is usually an equally effective treatment that preserves as much breast tissue as is possible. What’s more, studies have shown that mastectomy is no more effective than lumpectomy-plus-radiation at increasing survival rates for most women.

The following are a few conditions in which women are more likely to opt for, or require, a mastectomy:

• There are tumors in more than one quadrant of the breast.
• The tumor is too large to be decreased enough by pre-surgical chemotherapy to allow for lumpectomy/breast conservation.
• The diagnosis is inflammatory breast cancer.

And these are a few reasons why women might be encouraged to choose bilateral/double mastectomy:

• The patient is a carrier of one of the BRCA genes (carriers of these genes have a 65-85% likelihood of developing breast cancer over their lifetime as compared to 12% for the general population).
• There is a significant family history of breast cancer.
• There is extensive disease in both breasts.

Unless these conditions are present, most surgeons recommend breast conservation whenever feasible. The majority of women with breast cancer are good candidates for lumpectomy with radiation. Mastectomy is a much more complicated surgery, and one that requires at least 4 times the recovery time as compared to lumpectomy recovery time.

Reconstruction techniques have advanced, but often require multiple additional surgeries. While radiation may be an inconvenience, it’s generally very well tolerated. And, a woman can usually work through treatment, carrying on her everyday life with a 20-minute daily appointment over the course of 5-7 weeks.

Consider Your Life and Preferences When Making a Treatment Choice

Choosing a course of treatment has very high stakes—no woman wants to deal with a breast cancer diagnosis in the first place and, least of all, question that choice later on.

Virtua breast surgeons value respect, accessibility, and open doctor-patient dialogue. A woman facing breast cancer surgery should be able to ask any question on her mind—no question or concern is too small or unimportant.

Lifestyle issues, body image concerns, family member wishes, and individual preferences are all important to a woman’s life and her health care. We encourage our patients to consider all of these factors in making a treatment decision.

When empowering a patient to choose and face breast cancer treatment, the only factor we hope to erase is fear.

Updated January 14, 2022