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Despite increase, double mastectomies don’t have major impact on quality of life: study

por Lauren Dubinsky, Senior Reporter | March 10, 2016
Rad Oncology Radiation Therapy Women's Health
More and more women are opting to get contralateral prophylactic mastectomies (CPMs), also known as double mastectomies, but does it actually improve their quality of life? A new Duke Cancer Institute study found that there is little evidence to support that it does.

“Even though women imagine they will be much happier after CPM, we found that these patients’ experiences are not greatly different from those of patients undergoing a single mastectomy,” Dr. Shelley Hwang, chief of breast surgery at the Duke Cancer Institute, said in a statement.

Thanks to a study published in the September 2014 issue of The Journal of the American Medical Association, we know that CPMs have little impact on reducing deaths among women with cancer in only one breast. But its effect on their quality of life wasn’t known until now.
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The researchers surveyed almost 4,000 women who participated in the Army of Women, an organization committed to promoting patient engagement in breast cancer research, and underwent either a single or double mastectomy.

They used the patient-reporting tool, BREAST-Q, to measure the women’s psychosocial, physical and sexual well-being. They also evaluated their breast satisfaction in terms of breast symmetry, appearance, feel, fit in a bra and how it looks in and out of clothing.

They found that the women who chose to have a CPM were usually younger, had higher incomes and earlier stage breast cancer. Taking that and other factors into consideration, the study found that the CPM group reported slightly higher breast satisfaction than the single-mastectomy group.

They also found that breast reconstruction had a much larger impact on quality of life compared to just CPM alone. The researchers concluded that CPM does not translate into a much better quality of life in the way that breast reconstruction can.

Many women choose to undergo CPM because of fear that a new, second breast cancer might develop in that breast, according to breastcancer.org. And the numbers are rising — the September 2014 study found that 3.6 percent of the younger women had a double mastectomy in 1998 compared with 33 percent of younger women in 2011.

Many of the younger women with early-stage cancer in one breast and no genetic risk factors may be eligible for breast-conserving surgeries, instead of full mastectomies. Hwang said that unless a woman has a gene mutation that puts her at a significantly higher risk of a new cancer in the other breast, CPM doesn’t prolong life and it doesn’t lead to notably better quality of life.

Hwang said that, it’s important for women to have a better understanding of the risks and benefits of CPM. She believes that in order to have long-term satisfaction with regard to the treatment decisions, patients have to review all of the options, and the pros and cons associated with them.

“We need to continue to work hard to communicate these trade-offs accurately and effectively with our patients,” said Hwang.

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