This article reports findings from a paper published in the Journal of Clinical Oncology that demonstrate a rise in double mastectomies among women diagnosed with cancer in one breast. This may be overtreatment for many women. The story may have been more balanced by interviewing a patient who chose less treatment and her rationale for this choice.
The story cites breast cancer experts who note that there is little difference between the surgical treatments in terms of dying from breast cancer. Importantly, the story notes that having a mastectomy does not reduce a recurrence risk to zero, as some cancer cells may remain. The story notes that physicians should provide women with as much information about the survival benefit of all treatments, including less invasive options for reducing the risk of a recurrence. The story lists other non-surgical options for prevention and active surveillance for women at high risk of or having a recurrence, or developing a primary breast cancer.
An important oversight of the story is the lack of discussion of radiation, which is often given with lumpectomy. Lumpectomy alone is not comparable to mastectomy without radiation. The story might have benefited from listing data comparing lumpectomy and radiation with mastectomy. On this point, foregoing radiation due to another health condition and/or preferences to avoid side effects may play into a woman’s decision to undergo a mastectomy or bilateral mastectomy. The story also didn’t mentioned that some reconstruction procedures (e.g. tram flaps) can only be done once, so women considering those may have double and do both at once.
The story does not list the additional cost of surgical treatment and reconstruction for the prophylactic mastectomy. While the focus of the story was to report the increase in these procedures, the story could list the average cost and the time spent recovering from bilateral mastectomy and reconstruction.
The focus of the story was the increase in bilateral mastectomies in women diagnosed with breast cancer in one breast. The story notes that the survival difference between lumpectomy and mastectomy is about the same; however, the story does not mention that radiation is given with lumpectomy in order to reduce the risk of recurrence. Lumpectomy is not comparable to mastectomy without radiation. The story might have benefited from listing these data comparing lumpectomy and radiation with mastectomy. The story appropriately notes that having a mastectomy does not reduce a recurrence risk to zero as some cancer cells may remain.
The focus of the story discusses the recent increase in bilateral mastectomy after the diagnosis of cancer in one breast. This may be overtreatment for some women. The story notes that physicians should provide women with accurate information about the survival benefit of all treatments, including less invasive options for reducing the risk of a recurrence.
The story discusses recent data showing an increase in preference for bilateral mastectomy in women diagnosed with early breast cancer in one breast. These are women who would likely be candidates for either lumpectomy, lumpectomy and radiation or mastectomy. The story appropriately notes that having a mastectomy does not reduce a recurrence risk to zero as some cancer cells may remain.
The story does not engage in disease mongering. The story reports SEER data on the increase in bilateral mastectomy in women diagnosed with breast cancer in one breast.
The story cites Dr. Tuttle, the lead author of the study; a woman who decided to undergo a bilateral mastectomy, though she only had cancer in one breast; and Dr. Gralow, who questions the trend of prophylactic mastectomies in women who have the option to undergo lumpectomy and radiation, or lumpectomy alone (for DCIS). The story may have been more balanced by interviewing a patient who chose less treatment, along with her rationale.
The story notes surgical treatment options for women with early stage breast cancer. However, the story does not mention radiation with lumpectomy. Forgoing radiation due to preferences to avoid side effects may play into a woman’s decision to undergo a mastectomy or bilateral mastectomy. The story cites breast cancer experts who note that there is little difference between these surgical treatments in terms of dying from breast cancer. The story lists other non-surgical options for prevention for women at high risk of developing breast cancer, or having a recurrence. The story also didn’t mention that some reconstruction procedures (e.g. tram flaps) can only be done once, so women considering those may have double and do both at once.
The story notes surgical treatments available for women who are diagnosed with breast cancer. The story also notes via Dr. Gralow’s comments that women should be appropriatley informed about the absolute survival benefits of their treatment choices.
The increase in double mastectomy as prophylaxis after a cancer diagnosis is a new finding. The focus of the story discusses this data and attempts to explain this trend.
The story does not appear to rely on a press release and there are additional sources cited who are not affiliated with the study.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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