Christina Applegate's choice to have a double mastectomy puts her in the company of a growing number of women who are taking aggressive steps to avoid dying of breast cancer.
Studies show more patients are choosing mastectomies, even though women are just as likely to survive if they have smaller, breast-conserving surgeries.
Doctors say part of the trend has been spurred by technology: scans that can detect smaller, earlier cancers; sophisticated genetic tests that can warn women of their inherited risks; even new techniques in plastic surgery that make such radical surgery more appealing. But experts say some women are opting for mastectomy because their fear of cancer looms larger than concerns about their appearance.
Applegate, 36, was at high risk for breast cancer, both because her mother had the disease and because she carries a rare genetic mutation in a gene called BRCA-1, which increases the risk of developing aggressive disease at a young age. Women with this gene have up to an 84% risk of breast cancer.
Applegate told Good Morning America Tuesday that she had early-stage cancer in only one breast and had two lumpectomies.
She says she opted for a double mastectomy after learning she had the genetic mutation. Only about 5% to 7% of breast cancers carry these mutations, says Mehra Golshan, director of breast surgical services at Boston's Dana-Farber Cancer Institute.
Some women with the mutations opt to have preventive mastectomies even if they haven't been diagnosed with cancer. A recent study in the International Journal of Cancer, for example, found that 18% of women with the mutations took this approach.
Other women decide to have frequent screening with MRIs, or magnetic resonance imaging, instead of preventive surgery, says David Johnson of the Vanderbilt-Ingram Cancer Center in Nashville.
Doctors don't recommend MRIs for all women, says Minetta Liu, a breast cancer specialist at Georgetown's Lombardi Comprehensive Cancer Center. For most women, she says, doctors advise getting a yearly mammogram beginning at age 40.
Liu says insurance usually covers MRIs for women at high risk -- those with a close relative with breast cancer, such as a mother or sister; those with one of the genetic mutations; or those whose risk of breast cancer is more than 20%, based on a rating system called the Gail model.
Though MRIs are far more sensitive than mammograms, they also increase the chance that a woman will have a mastectomy, according a May study from the Mayo Clinic.
Mayo researchers found that breast cancer patients who had MRIs were more likely than others to have a breast removed, instead of a lumpectomy. That may be because MRIs are more likely to pick up second tumors in women who already are scheduled for surgery, Liu says.
In fact, in 16% of cases, MRIs find additional cancer in the affected breast. And in about 3% of cases, the MRI finds cancer in the opposite breast, says Julie Gralow, a breast cancer expert at the University of Washington.
Growing numbers of women are opting for double mastectomies when they have cancer in only one breast -- even when they lack the risk factors of women such as Applegate. Among women with cancer in one breast, the risk of developing a tumor in the other breast is less than 1% a year, says Isabelle Bedrosian of Houston's M.D. Anderson Cancer Center.
In 2003, 11% of women having a mastectomy in one breast opted to have surgeons remove their unaffected breast, as well, according to a study of 152,755 patients published last year in the Journal of Clinical Oncology. That's more than double the rate in 1998.
Liu notes that mastectomy may seem more attractive today because of improvements in reconstructive surgery.
Women have several reconstructive options, which can be performed at the time of mastectomy, Golshan says. Insurance generally covers the procedures. Doctors can reconstruct the breast using a flap of tissue from the stomach, back or buttocks, or with silicone or saline implants, Golshan says.
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