By NICHOLAS NG (NHS ’18)
The ubiquitous pink badges — symbols of the fight against breast cancer — represent the most successful disease awareness campaign in modern history. One would be hard-pressed to find those unfamiliar with the common ribbons. While the push to instill breast
cancer into mainstream consciousness has been a success, cultural and social misconceptions have influenced how Americans seek out treatment options. In particular, high profile patients have furthered a culture of aggressive, preventative surgical intervention, which will be the main focus of this editorial.
When faced with early stage breast cancer, one typically has two choices: undergo radiation and/or chemotherapy or pursue surgical options. However, the last decade has seen a marked rise in alternative surgical treatment plans that are not only preventative, but also highly proactive. One such operation is the contralateral prophylactic mastectomy (CPM). Especially popular among male patients, it removes the cancerous breast as well as the completely healthy, cancer-free one. Yet, the Journal of the American Medical
Association (JAMA) has found that these interventions have almost no impact on the ten-year survival of patients suffering from early stage breast cancer. Unless one tests positive for a risk-indicating gene, there is no empirically supported benefit of preemptive
double mastectomies. Still, in men alone, CPM rates nearly doubled from 2004 to 2011. Why then, do patients seek out double mastectomies when more conventional surgical and radiation treatments exist? Unfortunately, the answer owes
itself to social currents; high profile patients like Angelina Jolie have supported a rise in awareness as well as misconceptions about treatment. The trending belief among younger patients is that double mastectomies are the surefire way to eliminate the risk of cancer mortality.
While not incorrect, such an assumption is misguided, because the double mastectomy is not a treatment that provides superior outcomes when compared with other options (except when screening results are positive). Less invasive treatment plans that exclude the removal of the healthy breast are equally effective when examining ten-year survival.
Surgery is a decision not be taken lightly. Invasive procedures like the double mastectomy have permanent consequences that affect one’s life for years to come. I am by no means condemning the double mastectomy; it is in fact a highly effective treatment among patients who test positive in genetic screening. Furthermore, its purported cost when compared with traditional treatment options over a ten-year period is roughly equivalent. As with all medicine, the double mastectomy serves to give an often irreplaceable peace of mind. However, it is vital that we recognize that in many cases treating early stage breast cancer with double mastectomies yields a marginal health benefit. This reality should be factored into patients’ decisions as they weigh the deeply personal choice of how to proceed when faced with life-affecting treatment options.