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

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.”

Like all surgeries, mastectomy has some risks:

* Numbness of the skin along the incision site and mild to moderate tenderness of the adjacent area: Numbness and tenderness can happen because the nerves were cut during surgery.
* Extra sensitivity to touch within the area of surgery: Touch sensitivity is also due to irritated nerve endings. The sensation usually improves as the nerves grow back.* : Fluid collection under the scar may be the result of hematoma — an accumulation of blood in the wound — or seroma, an accumulation of clear fluid in the wound. Both usually resolve on their own or after being drained with a needle by your doctor.* : During mastectomy, the blood vessels that supply your breast tissue are cut. Occasionally that can present problems when your body tries to heal the incision site. If there isn't enough blood flow to the flaps of your incision, small areas of skin may wither and scab or need to be trimmed by your surgeon. This is uncommon and is usually not a serious complication.* : If infection happens, it can usually be discovered early and responds well to treatment. Talk to your doctor about the warning signs of infection.* : With mastectomy alone and mastectomy plus reconstruction, there is a risk for scar tissue to form and build up over time. Sometimes the scar tissue can be lumpy or painful. Your surgeon can tell you about ways to manage any discomfort.