Doctors have finally admitted that while just in case double mastectomies rates have trebled over the past decade, having a healthy breast removed if you have cancer in the other one will not increase your chances of survival. In fact, it’s likely to do more harm than good.

Doctors have finally admitted that while just in case double mastectomies rates have trebled over the past decade, having a healthy breast removed if you have cancer in the other one will not increase your chances of survival. In fact, it’s likely to do more harm than good.

A new study by Brigham and Women’s Hospital in Boston, US, shows that the majority of women would never have developed cancer in the healthy tissue, and that by removing the breast, they have only left themselves open to the complications of surgery.

In the study, the Boston researchers studied 500,000 breast cancer patients with stage 1 to stage 3 cancer in one breast between 1998 to 2012 to see if the disease returned or appeared in the other breast. They also compared the health and survival of those who’d had a single mastectomy, those who’d had the double mastectomy and those who’d had breast conserving surgery.

In fact, there was no survival advantage in getting even a single breast removed. The researchers found the same survival rates between those women who’d opted for breast-conserving surgery (like a lumpectomy) as those who’d had one or two breasts removed.

Nothing new
This story appeared last week in the headlines in the US and the UK as if it were shock-horror news.

But in fact, six years ago, the Cochrane Breast Cancer Group carried out a review of 39 studies involving some 7,000 women who'd had prophylactic (just-in-case) double mastectomies, some on two healthy breasts and others with cancer in one breast who chose to remove the other, healthy breast as a preventative measure.

The single well-controlled study looking at the difference between women who’d had a healthy as well as a cancerous breast removed showed no overall survival advantage.

What makes the Boston study particularly concerning is that rates of double mastectomies have trebled in the last decade, from 3.9 per cent in 2002 to 12.7 per cent in 2012.

This may be a possible ‘Angelina Jolie’ effect, after the actress announced she was having both healthy breasts removed after her doctors disclosed that her genetic profile rendered her highly likely to get breast cancer.

Risks of surgery
One aspect of this procedure that never gets discussed are the various risks women face when having just-in-case breast or ovarian surgery, factors that that actually increase the risks of getting cancer far more than so-called 'faulty' genes.

There is first of all, the not inconsiderable risk of surgery itself. Mehra Golshan, MD, distinguished Chair in Surgical Oncology at Brigham and Woman’s Hospital and senior author of the recent study, made mention of the downside of having a just-in-case operation as including “prolonged recovery time, increased risk of operative complications, cost, the possible need for repeat surgery, and effects on self image.”

The Cochrane study spelled it out more starkly, showed that up to 49 per cent of all the women opting for just-in-case double mastectomies suffered complications requiring repeat surgery.

Implant links with cancer
Furthermore, breast implants have been linked to a rare type of breast cancer known as 'anaplastic large-cell lymphoma' (ALCL), a form of non-Hodgkin lymphoma, increasing risk of contracting the disease by 18 times. JAMA, 2008; 300: 2030-5

Now that Jolie has chosen to have her ovaries removed and undoubtedly is taking HRT, the latest evidence from the major American Women’s Health Initiative study confirms that women who take the standard oestrogen/progestin HRT are more likely to develop breast cancer and die from the disease and 60 per cent more likely to die from any cause.

Living tissues like breasts are not like a car part that can be replaced with impunity. I’m still waiting for doctors to make a clean breast of the very real contribution that breast implants and artificial hormones make to the soaring incidence of breast cancer.