Skip to main content

When removing breast is not the answer

By Sarah Hawley, Special to CNN
updated 10:55 AM EDT, Wed May 15, 2013
The "Monday Night Countdown" crew sent love and well wishes on December 8 to ESPN sportscaster Stuart Scott, who has been battling cancer for the third time. The group joined hands during the broadcast while Suzy Kolber <a href='https://vine.co/v/Orp932pgPiU' target='_blank'>offered some tearful words</a>: "We want you to know we're sending you some extra strength and to keep fighting that fight." The "Monday Night Countdown" crew sent love and well wishes on December 8 to ESPN sportscaster Stuart Scott, who has been battling cancer for the third time. The group joined hands during the broadcast while Suzy Kolber offered some tearful words: "We want you to know we're sending you some extra strength and to keep fighting that fight."
HIDE CAPTION
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
Celebrities battle cancer
<<
<
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
>
>>
STORY HIGHLIGHTS
  • Sarah Hawley: Jolie, who's high risk, a good candidate for mastectomy, but word of caution
  • She says women with cancer in one breast increasingly having other breast removed too
  • She says risk of cancer in healthy breast is less than 1%; overtreatment a concern
  • Hawley: Women need control over health decisions, but must have accurate info on choices

Editor's note: Sarah Hawley is an associate professor in the Division of General Medicine at the University of Michigan and a research investigator at the Ann Arbor VA Center of Excellence in Clinical Management Research. Her primary research is in decision making related to cancer prevention and control.

(CNN) -- Angeline Jolie, who has stated that she is a carrier of the gene mutation BRCA1, appears to have been a good candidate for the bilateral prophylactic mastectomy she underwent recently to remove both of her breasts. In Jolie's case -- as with others who have openly discussed a similar action, such as Miss American contestant Allyn Rose and celebrity Sharon Osbourne -- the decision is appropriate: Having a genetic mutation, as these women do, puts a woman at very high risk for developing breast cancer in her lifetime.

But it possible that these very public decisions could lead more women with cancer diagnosed in one breast to consider having their second, nonaffected breast removed. This is called contralateral prophylactic mastectomy and it is on the rise in the U.S. Data from large cancer registry studies, for one example, have shown that the overall rate of CPM among women with stage I, II or III breast cancer signi´Čücantly increased from 1.8% in 1998 to 4.5% in 2003. Looking only at patients treated with mastectomy, the CPM rate grew from 4.2% in 1998 to 11.0% in 2003.

Sarah Hawley
Sarah Hawley

It is important, on the news of Jolie's decision, to caution women that CPM should be done only for the same reason as bilateral prophylactic mastectomies -- the presence of BRCA1 OF BRCA2. While many women who choose CPM do carry one of these genes, our research suggests that most do not.

Considered in the context of history, this is a jarring development. Back in the 1970s, women with breast cancer and their supporters pushed to have the option of breast conserving surgery (BCS or "lumpectomy") made available as an option to treat breast cancer.

They argued then that they should have access to a less invasive option than mastectomy (surgery to remove all breast tissue), particularly when randomized trials suggested the two treatments gave women the same chance of long-term survival. Yet in the United States we now find ourselves on the opposite end of the spectrum, with patients largely driving decisions -- electing to undergo this most extensive treatment option for breast cancer.

It would be almost unheard of for a woman without cancer to have a bilateral prophylactic mastectomy, as Jolie did, unless she had a genetic mutation.

Angelina Jolie reveals double mastectomy
CNN anchor opens up about her cancer
Wasserman Schultz on her breast cancer

So why would a woman who has cancer in one breast choose to have a second, healthy breast removed? Our research suggests that patients are worried about recurrence. But for the average breast cancer patient who has neither the BRCA1 or BRCA2 gene mutation nor a close relative with breast cancer (Jolie's mother, for example, died from ovarian cancer), the risk of a new breast cancer in the nonaffected breast is less than 1%.

Having the nonaffected breast removed will not translate into any additional survival benefit beyond what is conferred by treating the existing cancer. In fact, research has shown that many women who choose CPM could have been treated with only a lumpectomy, plus radiotherapy, in the affected breast.

Given the extent of the procedure, that CPM is done on patients without clinical reason raises strong concerns about overtreatment. This is perhaps the only example of removing a nonaffected organ based on what appears to be patient misunderstanding of the potential benefit of the surgery.

It's unlikely that a surgeon would agree to remove the entire colon of a patient with resectable colon cancer because the patient was worried about getting more colon cancer. Similarly, it is difficult to imagine a man with testicular cancer requesting to have both the affected and nonaffected testicles removed.

In this era of patient-centered care, women do need to feel empowered to make the choices that are best for them in treating their breast cancer. Yet because these choices are so difficult, it is imperative that they be based on accurate understanding of the risks and benefits of treatment. Perhaps we need to turn our attention to helping women remember why they advocated for less invasive options nearly 40 years ago.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Sarah Hawley.

ADVERTISEMENT
Part of complete coverage on
updated 4:08 PM EST, Sat December 13, 2014
The NFL's new Player Conduct Policy was a missed chance to get serious about domestic violence, says Mel Robbins.
updated 12:40 PM EST, Tue December 16, 2014
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
updated 11:00 AM EST, Wed December 17, 2014
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
updated 4:54 PM EST, Tue December 16, 2014
Gayle Lemmon says we must speak out for the right of children to education -- and peace
updated 5:23 AM EST, Wed December 17, 2014
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
updated 1:39 AM EST, Wed December 17, 2014
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
updated 3:20 PM EST, Fri December 12, 2014
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
updated 9:56 AM EST, Mon December 15, 2014
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
updated 4:01 PM EST, Mon December 15, 2014
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
updated 9:53 AM EST, Mon December 15, 2014
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
updated 5:53 PM EST, Sun December 14, 2014
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
updated 10:50 AM EST, Sun December 14, 2014
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
updated 4:23 PM EST, Sat December 13, 2014
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
updated 9:26 AM EST, Fri December 12, 2014
Anwar Sanders says that in some ways, cops and protesters are on the same side
updated 9:39 AM EST, Thu December 11, 2014
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
updated 12:38 PM EST, Sun December 14, 2014
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
updated 1:28 PM EST, Thu December 11, 2014
Rip Rapson says the city's 'Grand Bargain' saved pensions and a world class art collection by pulling varied stakeholders together, setting civic priorities and thinking outside the box
updated 6:10 PM EST, Sat December 13, 2014
Glenn Schwartz says the airing of the company's embarrassing emails might wake us up to the usefulness of talking in-person instead of electronically
updated 5:33 PM EST, Fri December 12, 2014
The computer glitch that disrupted air traffic over the U.K. on Friday was a nuisance, but not dangerous, says Les Abend
updated 12:40 PM EST, Fri December 12, 2014
Newt Gingrich says the CBO didn't provide an accurate picture of Obamacare's impact, so why rehire its boss?
updated 7:40 PM EST, Fri December 12, 2014
Russian aggression has made it clear Ukraine must rethink its security plans, says Olexander Motsyk, Ukrainian ambassador to the U.S.
updated 7:46 PM EST, Thu December 11, 2014
The Senate committee report on torture has highlighted partisan divisions on CIA methods, says Will Marshall. Republicans and Democrats are to blame.
updated 1:33 PM EST, Thu December 11, 2014
It would be dishonest to say that 2014 has been a good year for women. But that hasn't stopped some standing out, says Frida Ghitis.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT