Most people assume breast cancer is just a female thing. All those public service posters, fundraising walkathon T-shirts and stuffed animals marketed to raise awareness of the disease are typically saturated in pink, after all.
But about 1 percent of cases in the United States are actually in men -- and it turns out a growing number of them are choosing to do what Angelina Jolie did and remove both breasts to reduce the risk of any recurrence.
In a new study published Wednesday in JAMA Surgery, researchers report that the number of male breast cancer patients getting what's called contralateral prophylactic mastectomy (or CPM), which involves removing a healthy breast in addition to the one with a tumor, nearly doubled from 2004 to 2011 from 3 percent to 5.6 percent. The data came from the North American Association of Central Cancer Registries (NAACCR) and was large, with a sample of 6,332 men.
The trend towards more aggressive preventive measures in men mirrors what's happening in their female counterparts with breast cancer. The rate of CPM among women has also risen quickly, from 4.5 percent to 11 percent between 2003 and 2011.
The research conducted by the American Cancer Society and the Dana Farber Cancer Institute didn't delve into why this may be happening, but experts have suggested that the trend to do everything possible with preventive treatment may be due to the growing availability of genetic testing that give people a better sense of their risk, as well as what cancer specialists call the "Angelina effect." When the actress went public with her decision to have a double mastectomy two years ago after being told she had the BRCA1 gene mutation which put her at increased risk of breast cancer, many applauded her decision as a way of taking control over her own life.
The JAMA Surgery study comes at a time when more researchers, practitioners and activists are questioning the benefits of aggressive efforts to diagnose and treat breast cancer, arguing that all the public attention to "pink ribbon" breast cancer campaigns may have inadvertently influenced people to undergo potentially risky and costly treatments that may not help them.
One important study published last month in JAMA Oncology, for instance, found that aggressive interventions to treat the earliest stage of breast cancers called ductal carcinoma in situ have no effect on whether a woman is alive a decade later. The research tracked more than 100,000 women.
"We have created a culture of breast cancer awareness, and we’ve created a countercultural response of fear. When you do a mastectomy, you reduce the fear greatly," Steven Narod, a senior scientist at the Women’s College Research Institute in Toronto who led that study, told The Washington Post at the time.
Another much-debated study that came out this summer looked at the utility of mammograms by analyzing data from 16 million women in 547 U.S. counties in 2000. They found that the number of breast cancer diagnoses rose with more aggressive screenings. That was expected. The surprise was that the number the number of deaths remained the same. Study author Richard Wilson, a professor at Harvard University, argued that these findings "suggest widespread overdiagnosis."
Ahmedin Jemal, one of the authors of the JAMA Surgery study on men said in a statement that "health-care providers should be aware that the increase we've seen in removal of the unaffected breast is not limited to women, and doctors should carefully discuss with their male patients the benefits, harms, and costs of this surgery to help patients make informed decisions about their treatments." In some cases, experts warn, it may not be the right decision.
"The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care," said Jemal, who is vice president of surveillance and health services research at the American Cancer Society.