Mastectomy Mystery: Why It’s a Choice When Cancer Isn’t Evident

September 21, 2011

Why would a woman with cancer in one breast make the decision to have both removed, even if there is no indication that the cancer will develop in the other breast?

Researchers at Wake Forest Baptist Medical Center set out to answer that question. Their findings are published in this month’s issue of The American Journal of Surgery.

Lead author and researcher Marissa Howard-McNatt, M.D., assistant professor of surgery, said there has been a national trend of women with breast cancer choosing to have both breasts removed even though they only have cancer in one breast. She found this to be true even in women who tested negative for the BRCA 1 or 2 gene. BRCA is the cancer mutation gene that is found in families with high rates of breast cancer.

Doctors usually recommend bilateral mastectomies for someone who has breast cancer and also has the gene because they are at high risk for getting cancer in the other breast. Even if they don’t have breast cancer and they have that gene, they are still at a high risk for developing breast cancer, Howard-McNatt said. But little research has been done to explain why women without the gene are choosing to have their cancer-free breast removed.

“We tell them there are no good studies to show that removing both breasts will improve their overall survival,” Howard-McNatt said. “We’re not sure this is helping them, but they’re still choosing to have both removed.”

Howard-McNatt and colleagues set out to look for common factors among those women who decide to have a contralateral prophylactic mastectomy (CPM), also known as a bilateral mastectomy. Results revealed that of 110 women’s charts reviewed, no BRCA mutation was found in 61 percent, and of that number, 37 percent chose CPM. Among those who tested negative for the BRCA gene, but still chose to have CPM, the only common threads among them were being college educated, Caucasian and married.

Howard-McNatt acknowledges that this is a small, retrospective study, but she already has more research underway to go more in depth on this issue. She suspects there is more of a “fear factor” at play among the married women who test negative, but can’t determine that just by looking at data and charts.

“Women who are testing negative for the gene are still choosing to have both breasts removed, but we don’t know why,” said Howard-McNatt. “There’s not a lot in the literature that looks at this and that’s what my next study will focus on.”

With National Breast Cancer Awareness Month being observed in October, Howard-McNatt said it’s important for diagnosed women to be armed with information and to discuss all of their options with their doctors. They should also ask about BRCA testing if they have a family history of breast cancer – a first degree relative such as a mother, daughter or sister – and meet with a genetic counselor who can help calculate their risks.

“Those women who test positive for BRCA, their life-time risk may approach 87 percent of developing breast cancer, and doctors recommend they have bilateral mastectomy,” Howard-McNatt said. “If they don’t want to have a mastectomy, they need to have close surveillance every six months for the rest of their lives. It’s their choice which one they want to do.”

Co-authors of the study are:  Rebecca W. Schroll, M.D., Edward A. Levine, M.D., and Gail J. Hurt, BSN, all of Wake Forest Baptist.

Media Relations

Bonnie Davis:, 336-713-1597