Choosing Radical Cancer Surgery

Terri Nimmons of Laurel, at home with daughter Sara, chose double mastectomy after a diagnosis of breast cancer and said the decision helps her to feel
Terri Nimmons of Laurel, at home with daughter Sara, chose double mastectomy after a diagnosis of breast cancer and said the decision helps her to feel "safer." (Family Photo)
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By Rob Stein
Washington Post Staff Writer
Tuesday, February 5, 2008

When Cheryl Lawrence got a diagnosis of breast cancer, her surgeon told her she could save her breast. But Lawrence decided to have it removed anyway. And then she decided to have the healthy one removed, too.

"I didn't want to ever have to deal with this again," said Lawrence, 40, of Olympia, Wash. "I just didn't want to have to worry about it. For me, it was a matter of peace of mind."

Lawrence is not alone: The proportion of breast cancer patients who are opting for double mastectomies when far less radical surgery would suffice has increased sharply, a trend that disturbs some experts. They say too many women may be taking the drastic step in the panic that often follows a cancer diagnosis, or with the mistaken belief that more aggressive surgery will improve their survival odds.

"I think this is a very high price to be paying for a sense of peace of mind," said M. Carolina Hinestrosa of the National Breast Cancer Coalition, a D.C.-based patient advocacy group. "It's turning back the clock and kind of giving up. That, in my mind, is not progress. It is draconian."

But others argue that the trend may in some ways demonstrate women taking more control of their medical care.

"When I first heard this I was surprised. We've invested a couple of decades working on doing less surgery for breast cancer as opposed to more," said Julie Gralow, who treats breast cancer patients at the University of Washington in Seattle. "But we're empowering patients to make their own decisions as opposed to a few decades ago when we told women what to do. For women who have done their research and are making a very conscious, educated choice, it's not a choice out of fear. It's what's right for them."

Many women who choose this option, she noted, also undergo reconstructive surgery.

"Part of it may be that our plastic surgery options are better, so the thought of having a breast removed might for some women be somewhat less traumatic if they can have a reconstructed breast," Gralow said. "Some women are fairly comfortable with their body image, and this is something that is going to help them sleep better at night."

For years, women with breast cancer had one or both breasts removed in a procedure known as a radical mastectomy -- an approach that eventually was abandoned as unnecessarily disfiguring. Research showed that many women are just as likely to survive if they undergo a lumpectomy, which involves removing only the tumor and a small amount of tissue around it, often followed by chemotherapy and radiation.

But in recent years, doctors started noticing that more women were opting for double mastectomies.

"Women who had a small tumor in one breast who could have simply had a lumpectomy are having both breasts removed," said Todd M. Tuttle of the University of Minnesota.

Tuttle and his colleagues examined data from large federal health surveys and found that the rate of patients having both breasts removed rose from 1.8 percent to 4.5 percent between 1998 and 2003 -- a 150 percent increase.

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