The number of women opting to have mastectomies is on the rise, according to a new report from the federal government. The research, released Feb. 22 by the Agency for Healthcare and Quality (AHRQ), found that while breast cancer rates remained stable, the number of women undergoing mastectomies increased 36 percent between 2005 and 2013.
AHRQ’s analysis also showed that both single and double mastectomies are increasingly being performed as outpatient procedures. The number of mastectomies performed in hospital-based ambulatory surgery settings climbed to 45 percent in 2013.
“This brief highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety,” AHRQ Director Rick Kronick, PhD, said in an agency news release. “More women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures.”
AHRQ”s findings — drawn from analysis of data from 13 states and covering 25 percent of the U.S. population — show that the overall rate of mastectomies rose from 66 per 100,000 women in 2005 to 90 per 100,000 in 2013. The increase in double mastectomies was especially high, with the rate more than tripling from 9 out of 100,000 women to 30 out of 100,000 women. Overall, 33 percent of all mastectomies were double mastectomies in 2013.
According to the report, many of the women who had double mastectomies only had cancer in one breast, but chose to have both breasts removed as a preventive measure. Others chose double mastectomies to ensure a symmetrical look after reconstructive surgery.
The agency’s data analysis also showed that the rate of women who did not have cancer but had bilateral mastectomies doubled. This number, however, remains low, with 2 women in 100,000 choosing surgery without a cancer diagnosis in 2005, compared with 4.4 women per 100,000 in 2013.
Why would a woman have both breasts surgically removed if she doesn’t have cancer? The researchers point to studies that show women who have a family history of the disease or who are genetically predisposed to breast cancer because they are carriers of BRCA gene mutations choose double mastectomies as a preventive measure. This option gained worldwide attention when actress and director Angelina Jolie had a double mastectomy after learning she carried a BRCA gene mutation that put her at a high risk for breast cancer.
However, many cancer physicians view preventive surgeries as overly aggressive, particularly in women without a genetic risk factor. Robert Shenk, MD, medical director of the Breast Cancer Center at University Hospitals’ Case Medical Center in Cleveland, told ABC News that he has seen more and more patients want to take extreme action after a breast cancer diagnosis, even if a lumpectomy was initially advised.
“They’re asking for mastectomies more and come in and say ‘I want to have both my breasts removed,’” Shenk said, explaining that some patients think the cancer can spread to the second breast. “They overestimate the risk it can come back.” His concern, he said, is that women are choosing these invasive surgeries to feel “safe” even if a less invasive lumpectomy would be an option with a high cure rate.