Choosing Radical Cancer Surgery

Teal said she usually recommends the least amount of surgery necessary but can understand why some women want to do more.

"I often require that they come back and see me. They often meet with the plastic surgeons and go over the data, and in the end if it's their wish to do it and they are well informed, I'm willing to do it," she said.

The trend is understandable but disconcerting, Hinestrosa said.

"You can understand a woman facing a diagnosis of breast cancer will want to do anything she can to save her life, but the data tells us that taking that radical step may reduce the risk for another breast cancer in the opposite breast but in fact does nothing for improving your chances of survival," Hinestrosa said. "We need to do a better job in educating women and identifying what puts them at risk in the first place."

Nancy E. Davidson, a breast cancer expert at Johns Hopkins University who heads the American Society of Clinical Oncology, said she is concerned, too.

"I think we need to make sure we're counseling women appropriately," Davidson said. "I hope this reflects women getting considerable counseling and using that information to figure out what is best for them. But I think that's a question that we have to address."

Susan Love, a breast cancer expert at the University of California at Los Angeles, worries that doctors are not spending enough time explaining the options.

"When you are first diagnosed, you are in a panic and you think if you offer your breast to the gods you'll get your life back," Love said. "We think in America that more is always better. If you have the bigger, more aggressive operation, it's always better. That's our mind-set, and so many women say, 'Let's just have it off,' and the surgeon says, 'Okay.' I think it's turning back the clock."

But Lawrence, Edmonds, Elmore-Nesheim and other women said they made their decision after carefully weighing the choices.

"I wasn't considering it, but then suddenly I thought, 'I don't want to live with the fear of cancer in the other breast,' " said Terri Nimmons, 49, of Laurel, who opted for a double mastectomy after her diagnosis in June. Her sister had died of breast cancer and she worried about not being around for her 8-year-old daughter.

"I had seen the disease up close and in person, and that really stayed with me. When a mother gets breast cancer, the whole family is going to go through it with her. I'm not willing to put everyone through that again," she said.

Although the surgery was difficult, Nimmons and the other women believe they made the right decision.

"I don't think I realized how profound it would be for both my natural breasts to be gone," Nimmons said. "I'm still mourning the loss. But the diagnosis just shook my whole sense of feeling safe. This just felt like a way of feeling a little safer."