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More women with ductal carcinoma in situ (DCIS) in one breast are choosing to have both breasts removed. Fourteen percent made that decision in 2005, compared to only 4% in 1998.
Most women who have small DCIS tumors can be treated effectively with breast-conserving lumpectomy and radiation. Mastectomy is recommended when tumors are large or appear in different areas of the breast. Whether DCIS is treated with lumpectomy and radiation or mastectomy, 10-year survival rates are the same: 98-99%. For most women, removing the opposite healthy breast does not improve this survival rate.
So why do women choose to remove healthy breasts? Some reasons might include:
A perceived risk for developing a new cancer in the opposite breast. Women often choose prophylactic mastectomy not because of their doctor’s recommentation, but because they fear another diagnosis. After having cancer in one breast, the risk of developing a new cancer in the opposite breast is about 1% per year (10% risk in 10 years). That may be more risk than many women feel they can handle.
A real risk for developing a new cancer in the opposite breast. Women who have multiple tumors in the breast, invasive tumors in addition to DCIS, an inherited genetic predisposition, or a strong family history of breast cancer are at higher risk. Although mastectomy is drastic and irreversible, for these women it is the most effective means of risk reduction.
Other reasons may also contribute to the decision to have mastectomy. Women are hearing more about mastectomies, from women they know and the media. Achieving symmetry, even with reconstruction, can be difficult after losing one breast, while sophisticated new reconstruction techniques recreate nautral-feeling and natural-looking breasts. For many, knowing their breasts can be reconstructed makes mastectomy more acceptable.
If you have DCIS or any type of cancer in one breast, be clear about your lifetime risk for recurrence and new cancers. Consider all risk-reducing options, including surveillance, hormonal therapy, preventive medication and mastectomy before making the decision that is right for you.
More information can be found at www.breastcancer.org
June 12, 2009