Satisfaction High With Mastectomies


Wednesday, July 19th 2000, 12:00 am
By: News On 6


CHICAGO (AP) — Seventy percent of women who had their healthy breasts removed in hopes of avoiding breast cancer reported being satisfied with their decision some 14 years later, a Mayo Clinic study found.

The study looked at the psychological consequences of the most drastic treatment available to women who run a high risk of breast cancer because of a family history of the disease.

A related Mayo study of 950 women suggested that the surgery is also the most effective option. That study, published in 1997, found that high-risk women who had both breasts removed reduced their cancer risk by about 90 percent.

The psychological study was reported in Wednesday's Journal of the American Medical Association. The participants were mostly studied before screening became available for the so-called BRCA gene mutations that are linked to breast cancer, but many of the women had a strong family history of the disease.

Genetic breast cancer is rare, accounting for between 5 percent and 10 percent of all cases, but at least half of all women with susceptible genes will develop the disease by age 70, according to the American Cancer Society.

The options for high-risk women include regular screening; tamoxifen, a potent drug with potential side effects; and having both breasts removed before cancer even occurs. The surgery is called a bilateral prophylactic mastectomy.

Lori Edell said she doesn't think about cancer every day now, three years after she decided to have surgery to remove both her breasts.

``I have two small children who I want to see grow up, so it was an easy decision,'' said Edell, a 41-year-old New Jersey pharmacist who was not involved in the research.

Edell said if she hadn't had the surgery, she probably would have ended up like her mother and aunt, ``going through early detection, knowing they were probably going to get breast cancer anyway, and they died from it.''

The researchers questioned 572 of the 950 women who had prophylactic mastectomies at the Mayo Clinic between 1960 and 1993. Participants included six women who developed cancer after undergoing mastectomies, and all said they still were psychologically satisfied with their decision.

Nineteen percent were dissatisfied, mainly because they were unhappy with their altered body appearance, said Marlene Frost, a Mayo nurse researcher and the lead investigator. Eleven percent were neutral.

Most of the satisfied women said they worried less about cancer and experienced no change in their sex lives and feelings of femininity.

Only about 20 percent of high-risk women say they would consider prophylactic mastectomies, and even fewer actually choose to have the surgery, Frost said.

The exact number of women who have the surgery is uncertain, but Frost and other scientists said it has probably become less common since genetic testing became available.

Before, the surgery was presented as an option for women with a strong family history of the disease. Now, it generally is considered only by women known to be BRCA carriers, said Dr. Funmi Olopade, director of the University of Chicago's cancer risk clinic.

The findings should be reassuring for women at genetic risk who may be considering preventive surgery, said Dr. Eric Winer, director of breast oncology at Dana-Farber Cancer Institute.

But he also said the 19 percent who were dissatisfied shouldn't be discounted, especially since the study suggests they may have felt pressured by their doctors. Because surgery is drastic and irreversible, the decision ultimately should be up to the patient, he said.

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On the Net: American Cancer Institute: http://www.cancer.org