Article Submission Detail:

Article Title: Why So Many Unnecessary Mastectomies?
Author Name: Dr. Kathleen Ruddy
Contact Email Address: drruddy@...
Word Count: 1309
Suggested Category: women's health
Keywords: Dr. Kathleen Ruddy,mastectomies,breast cancer,
oncology,non-invasive breast cancer,DCIS,mammography,women,
tamoxifen,radiation
Description: There has been an alarming increase in
mastectomies for non-invasive breast cancer. Discover why some
of these mastectomies may have been unnecessary and what
alternative treatments are available.
Copyright Date: 2009

You have permission to publish this article in your ezine
or on your web site, free of charge, as long as the byline
and the article is included in it's entirety. If you use the
article you are required to activate any links found in the
article and the by-line. You may not use this article in any
publication that is not-optin (spam).

Complete Article with Resource Box at end:

Why So Many Unnecessary Mastectomies?

As if the collapse of the world financial system isn't enough to
set one's nerves on edge, a study just published in the Journal
of Clinical Oncology reveals yet another alarming trend: during
the past several years the percentage of women with non-invasive
breast cancer (DCIS) who have their breasts removed entirely
(mastectomy) has increased 188%! Since mastectomy is not at all
required to treat the vast majority of patients with DCIS, the
looming question then becomes "Why are all of these women having
their breasts removed?"

Allow me to review some important facts. Non-invasive breast
cancer (DCIS, commonly known as ductal carcinoma in-situ) is not
life threatening. It is the earliest stage of breast cancer and
it does not have the ability to move beyond the breast tissue to
invade other organs of the body. Unless DCIS is very large at
the time of diagnosis, which is seldom the case these days, it
is very adequately treated with lumpectomy and radiation therapy.
Most of the time DCIS is diagnosed by mammography and is
relatively small in size. Typically, it cannot be felt as a lump
and is seen only as microcalcifications on a mammogram. The
chance that DCIS will recur after proper treatment is
approximately 1 in 100 women diagnosed with the disease per
year. Which is to say, at ten years of follow-up, 10 women in 100
with DCIS might have had a recurrence and the other 90 will be
completely free of disease. So why are all of these breasts
coming off? And, furthermore, why are so many women having
their other perfectly normal breast removed at the same time?

The study reported in the Journal of Clinical Oncology was not
meant to try to answer these questions but rather it was meant
to report the "state of play." Nonetheless, I think it is fair
to wonder why all of these breasts are being removed if they
don't have to be. My own suspicion, after spending the past
fifteen years rescuing women and their breasts from overly
aggressive surgeons, is that women are being unnecessarily
frightened and coaxed into aggressive surgery in the false
belief that this will provide an improved survival. Of course,
most women are naturally afraid of breast cancer. And when they
are diagnosed with the disease they are usually surprised and
alarmed. They are vulnerable to any suggestion they think might
improve their chances of "cure" and they want to do everything
they think might help them "beat the disease." I believe these
women are being subtly encouraged to have mastectomies that they
do not need and that will not add one day to their life.

A few more facts: women who have been diagnosed with DCIS have
an increased risk of developing a similar breast cancer in the
opposite breast. However, the risk of "contralateral" breast
cancer is also very small - only about 1 in 100 women with DCIS
will develop disease in the opposite breast every year following
their initial diagnosis. (And medications, like tamoxifen and
arimidex, reduce this already small risk even further.) To put
it another way: after 10 years of follow-up, 90% of women have
not developed disease in the opposite breast. And those that do
can be treated with lumpectomy and radiation therapy - as can be
done for the original tumor. Mastectomy is not necessary to
properly and adequately treat DCIS! Furthermore, it is
certainly not necessary to remove a perfectly normal breast that
in 90% of women will not develop a breast cancer over the
subsequent ten years following diagnosis of the original disease.

If 90% of women with DCIS do not develop disease in the opposite
breast during the ten years following their first treatment, why
(all of a sudden) is there such a stampede for contralateral
prophylactic mastectomy? Does this have something to do with
the increasing numbers of plastic surgeons on the market?
Perhaps, I can't be sure. But I do know one thing - these
mastectomies are not necessary. The fact that prophylactic
mastectomies have increased by 188% is nothing short of alarming.

In the recent report even women with DCIS in one breast who
underwent breast-conservation in the breast that had the cancer
had a 148% increased incidence of prophylactic mastectomy in the
opposite breast - the perfectly normal breast! So, the breast
with the cancer is "saved" and the perfectly normal breast is
removed! This is just plain crazy. The breast that has the
cancer gets to "live" and the opposite breast, without the
cancer, has to go. What planet are we living on?

Even though removal of the breast certainly reduces the
likelihood that a breast cancer can grow there, it does not add
one day to the overall survival of the patient. So, what's the
point? If prophylactic mastectomy is offered in order to reduce
the anxiety and worry that the cancer might come back, or that
it might occur in the opposite breast, I think women need to know
that the risk of this happening is rather small: only 1% per
year for every 100 women with the disease. This fact ought to
reduce the patient's anxiety considerably. It certainly has for
my patients.

The proof that overall survival is not compromised by
breast-conservation and radiation therapy has been documented
repeatedly in dozens of studies conducted all over the world.
In my own experience, when the Cancer Registry at my hospital,
Clara Maass Medical Center in Belleville, New Jersey, reviewed
my patients with DCIS they found that I performed 50% fewer
mastectomies than other surgeons at my hospital, in my state and
(on average) around the country. They also discovered that the
recurrence rate for my patients was ten times lower than
elsewhere in the state or the nation.

Again, in the vast majority of cases mastectomies for DCIS are
not necessary. Recurrence of breast cancer is low if the
disease is treated properly; overall survival is well maintained.
Women do not have to sacrifice their breasts in order to save
their lives. In summary, women with DCIS should not be
frightened into having unnecessary surgeries that are risky,
mutilating and provide no survival advantage.

I am certainly in favor of preventing breast cancer. I am
particularly interested in preventing the recurrence of breast
cancer. But the most important thing is to reassure women and
give them the correct information about their true risks. DCIS
is a non-invasive breast cancer. It does not threaten a woman's
life. It can be treated very well with lumpectomy and radiation
therapy. A woman with DCIS can keep her breast. She does not
need mastectomy. She can keep her opposite breast also. If she
should develop breast cancer in the opposite breast she can have
breast-conservation with radiation therapy on that breast, too.

If women understood that mastectomies do not increase their
survival, if women fully understood that breast-conservation is
perfectly acceptable as treatment for DCIS, then I believe there
would be far fewer therapeutic or contralateral "prophylactic"
mastectomies. Those few women who feel that they cannot
tolerate the anxiety that DCIS might recur can surely have
mastectomy: but they will be few and far between, I am sure.

I wish more women were given the proper counseling, reassured
about the relatively low risk of recurrence of DCIS and offered
the least treatment that will provide cure and relative peace of
mind - breast conservation and radiation therapy. Hopefully,
this message will gain enough currency in cyberspace to help new
patients with DCIS save their breasts as they strive to save
their lives.

Reference

Tuttle, TM. Increasing Rates of Contralateral Prophylactic
Mastectomy Among Patients with Ductal Carcinoma In-Situ.
Journal of Clinical Oncology, 2009. 27: 1362-67.

(c) 2009, Dr. Kathleen Ruddy. All rights reserved. Reprints
welcomed so long as article and by-line are not edited and all
links are made live.

Dr. Kathleen Ruddy, Founder and President of the Breast Health
and Healing Foundation, is a breast cancer surgeon who is
dedicated to finding the causes of breast cancer and using that
knowledge to prevent the disease. You can find further details
at http://www.BreastHealthandHealing.com/