More women in the United States are undergoing mastectomies, even though the overall rate of breast cancer has remained stable, a new federal government report reveals.
The rate at which American women opted for mastectomy jumped by more than a third (36 percent) from 2005 to 2013, according to data from the U.S. Agency for Healthcare Research and Quality (AHRQ).
In sheer numbers, the mastectomy rate increased from 66 to 90 per 100,000 women during the study period. There was a particularly steep climb in double mastectomies, which more than tripled: From nine to 30 per 100,000 women. By 2013, double mastectomies accounted for one-third of all mastectomies, the AHRQ said.
Double mastectomies seem to be happening at a younger age, as well, the report found. In 2013, women who had double mastectomies were about 10 years younger than those who had single mastectomies — an average age of 51 years versus 61 years, respectively.
The rate of women without breast cancer who underwent preventive double mastectomies also more than doubled, from two to more than four per 100,000 women, the report found.
Some women with a genetic risk for breast cancer may undergo a double mastectomy as a preventive measure, even if they do not have cancer. Most notably, in 2013, actress and director Angelina Jolie made headlines when she announced she would undergo a double mastectomy after learning that she carried a variant of the BRCA1 gene that raises the risk for breast cancer.
The new report also found that both single and double mastectomies are increasingly being performed as an outpatient surgery. In 2013, 45 percent of all mastectomies were outpatient procedures, the AHRQ report found.
The data “highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety,” Rick Kronick, AHRQ director, said in an agency news release.
“More women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures,” he added.
One breast cancer specialist believes that a number of factors may be driving these trends.
Dr. Stephanie Bernik said the overall survival rate of breast cancer patients who opt for mastectomy or a more conservative, breast-preserving “lumpectomy” is roughly the same. Still, women are increasingly choosing the more radical procedure.
“Some of the reasons behind this trend are likely due to increased genetic screening, improved reconstruction options and a woman’s desire to potentially reduce the chance of developing a breast cancer in the opposite breast,” said Bernik. She is chief of surgical oncology at Lenox Hill Hospital in New York City.
“What most studies fail to acknowledge is that although survival may not be improved by [preventive mastectomy], it does decrease the chance of developing a second cancer in the opposite breast,” she added. “Furthermore, with improved reconstructive options, many patients opt for a bilateral procedure for symmetry.”
Another breast cancer expert believes that the patient’s “emotional journey” is often key to decisions involving breast surgery.
Dr. Frank Monteleone directs the Breast Health Center at Winthrop-University Hospital in Mineola, N.Y. He said that even though a mastectomy is not always medically warranted, “some women would rather endure the mastectomy rather than go through frequent mammograms and potential biopsies down the road, which can produce anxiety each time.”
The new report is based on data from 13 states with more than 25 percent of the United States’ population. AHRQ is part of the U.S. Department of Health and Human Services.
Breastcancer.org has more about mastectomy.
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