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Prevention is better than cure, the old saying goes. It makes sense. It doesn’t make sense to have perfectly healthy parts of the body cut off to achieve it. Hollywood star Angelina Jolie did just that last year. She had a prophylactic double mastectomy – surgical removal of both healthy breasts to reduce the risk of cancer in future. At the time, I wrote a blog about the medical Pandora’s box she opened, even with a family history of the disease, and the mutated gene that is said to up the risk. Some experts believe her decision to have the drastic surgery may not have been such a smart move.
It’s slightly easier to understand why some women who get cancer in one breast choose to have the other lopped off ‘just in case’. The number doing that has grown so rapidly in recent years, doctors say it’s ‘close to an epidemic’. New US research shows that most women who have a double mastectomy don’t need it. It shows that doctors need to do far more to calm patients’ fears without resorting to unnecessary, aggressive and mutilating treatment. MS
By Marika Sboros
Hollywood star Angelina Jolie opened a ‘medical Pandora’s box’ when she had both her healthy breasts surgically removed in 2013, to reduce her risk of breast cancer
Many women diagnosed with cancer in one breast have the other healthy breast removed as a “precautionary measure”, say US scientists. In most cases, they say these women don’t need the double mastectomy.
Their study, in the latest issue of the JAMA (Journal of the American Medical Association), shows that many women are so filled with fear, they demand that doctors remove the other healthy breast , “just in case”, even when they are not at high risk, and it is unlikely to increase their survival chances.
The researchers, from the University of Michigan, Ann Arbor’s department of internal medicine, looked at 1,447 women who had treatment for breast cancer in one breast, with no recurrence. They found that close to seven out of 10 who had the dual procedure, known in medical terms as contralateral prophylactic mastectomy, had no “clinical indication” for it – they were not at high risk of cancer in the healthy breast, and the procedure did not increase chances of survival.
The study defined clinical indication as a family history of breast cancer, or the presence of a specific gene mutation. Both are shown to raise the risk of breast cancer.
Fear of developing cancer in the healthy breast has shown up in earlier research as a big driver of contralateral prophylactic mastectomy. In the new research, Dr Sarah Hawley, an associate professor of internal medicine at the Michigan University of Michigan, Ann Arbor, and others say the fear is often “out of proportion” to actual risk.
Crippling fear
A HealthDay News report quotes US breast oncologist Dr Ann Partridge in an editorial accompanying the study, saying it’s a “reasonable thing to be fearful of recurrence”. Doctors hope that “fear motivates (women) to comply with treatment”, says Partridge, director of the adult survivorship programme at the Dana-Farber Cancer Institute in Boston, in the report, but “what you hope the fear doesn’t do is cripple them”.
The research shows that other factors besides fear are behind the rise in numbers of women having contralateral prophylactic mastectomy. The HealthDay News report says genetic testing and advanced imaging screening such as MRI also play a role. It quotes Hawlyer as saying that MRIs may often reveal areas that look suspicious but turn out to be nothing, but even so, that can trigger fear.
Interestingly, the research also shows that the more educated women are, the more likely they are to make such a radical decision.
Fear was certainly a driver in Hollywood actress Angelina Jolie’s decision to have both her health breasts removed last year. Her case is different from the women in Hawley’s study, but no less disturbing in its implications.
Jolie had the double mastectomy after doctors said her risk of developing breast cancer was a whopping 87%. Jolie does have a strong family history – her mother died in 2007, aged just 56, after a 10-year battle with breast cancer, and one of her aunts has the disease – and tests showed she carries the mutated gene that significantly ups the risk.
Some specialists said Jolie was “brave” to have the surgery, as I noted in a blog I wrote for Business Day at the time on the “medical Pandora’s box” her decision opened. Partner and fellow actor Brad Pitt called her “heroic”. According to the couple’s press releases, she had the surgery because she didn’t want to deprive her brood of six children – three adopted from different countries and three with Pitt – of their mother prematurely.
Duped by doctors
Some specialists suggested Jolie was “duped” by her doctors, however well meaning, and by medical science, as I said in a blog I wrote for Business Day at the time. They pointed out that there’s a big difference between relative and absolute risk of developing any disease, and there are other safer, far less invasive ways of protecting the body from cancer, including lifestyle change and nutrition than mutilating surgery.
There’s truth in that, because cancer is a systemic disease, and hacking off healthy parts of the body is not the best way to ensure it won’t pop up somewhere else. And in the case of cancer in one breast, oncologists say the greatest risk is not of cancer in the other breast, but of a spread elsewhere in the body.
Just as worryingly, experts say the exquisite Jolie’s celebrity status could encourage more women to follow her example, and maim themselves for no good reason. As I said at the time, Jolie was right to be terrified out of her wits after what her mother went through to fight breast cancer for 10 years, and die prematurely from it aged just 56 in 2007.
The actress was even said at the time to be considering surgery to remove her presumably health ovaries to lower her risk of breast cancer even further.
All this makes prophylactic mastectomy look more like madness rather than real medicine, especially since compelling research points to the benefits of a much gentler, more holistic approach.
Partridge is quoted in a Reuters report as saying: “We don’t want women having regrets or complications they do not need.” Her message in the report is simple enough: “If you’re not sure what to do, wait. You can always take the breast off, but you can’t put a natural breast back on.”
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