Choosing Radical Cancer Surgery

Younger women, white women and women with a previous cancer diagnosis were more likely to make that choice, the researchers reported in October in the Journal of Clinical Oncology.

While the surgery reduces the risk of getting a second cancer, it does not eliminate the risk and it does not lessen the chances of dying from breast cancer. That is because second breast cancers are usually caught early and can be treated effectively.

"If women are choosing this because they think it will improve their survival and allow them to see their children graduate from high school, we may not be educating patients enough," Tuttle said.

His study did not examine the reasons for the trend, but Tuttle suggested several explanations. One might be that more women are getting tested for breast cancer genes, and those who carry the genes and then develop the disease may be opting for the most extensive surgery.

More aggressive screening with technologies such as MRI is also producing more false positives, and that can mean a biopsy.

"It starts to become overwhelming and you start to think that this is what your future is going to be -- having possible false positives and callbacks and biopsies," said Christine Teal, director of the breast cancer center at George Washington University. "That plays into patients saying, 'Do I want to be dealing with this the rest of my life?' "

Andrea Edmonds, 37, of Silver Spring decided to have her healthy breast removed a year after a single mastectomy because she couldn't shake the fear of another cancer.

"I was constantly worried about it. I lost a lot of weight," said Edmonds, whose test for one of the breast cancer genes came back inconclusive. "I didn't trust my body anymore, and wanted to remove the parts that could cause more problems down the road."

For younger women, the prospect of many years of worry may be especially daunting.

"I didn't want to be sitting around for the rest of my life waiting for the cancer to come back," said Debra Elmore-Nesheim, 43, a nurse in St. Paul, Minn., who chose a double mastectomy over a lumpectomy in 2006. "For me, the peace of mind that I was doing everything I could to take hold of my life was more important than keeping my natural breast."

Procedures for breast removal and reconstructive surgery have improved, making the situation less traumatic and producing better results, several experts said.

"Many times the decision is made because they can have a reconstruction done that may provide more symmetry, and they can get everything taken care of at one time," said Shawna Willey, a surgeon at Georgetown University.