For women with early stage breast cancer, it’s a very difficult choice.

There’s mastectomy—entire removal of one or both breasts—or there’s less invasive “breast-conserving surgery” (BCS), which aims to remove only the cancerous cells.

A recent survey found that mastectomies increased by 36 percent from 2005 to 2013—from 66 per 100,000 women to 90 per 100,000. The increase was driven mainly by women choosing to have double mastectomies.

That’s a significant jump for a serious intervention.

I needed to know why.

Troubling details

I wasn’t surprised that most women who chose a double mastectomy had been diagnosed with cancer. But the rate of women without a cancer diagnosis, who chose a double mastectomy to prevent a feared future cancer, more than doubled.

Why?

Let’s look at another trend in women’s’ treatment choices and see if there’s a match.

Health non-insurance?

Some 45 percent of women choosing mastectomies had the procedure done as an outpatient procedure, aka a “drive-by.”

Major surgery, in-and-out, same day?

That can’t be right. But that’s double the 22 percent outpatient rate 10 years ago.

Again—why?

Patient advocates are concerned. We all should be. You don’t need an MD to understand that a mastectomy is a physically and emotionally traumatic procedure. For hospital-based inpatient mastectomies, a postoperative stay of just over two days is the norm. Advocate groups have supported a minimum two-day stay for years.

A key premise here, sadly—and maddeningly—is that insurance companies are driving the trend toward drive-by mastectomies. The finger of blame has pointed that way for years.

Indeed, some 10 years ago, patient advocates in 20 states successfully lobbied their local legislators to make it illegal for insurers to impose rates that force women out of the hospital less than 48 hours after breast surgery. (Many attempts to pass similar federal legislation have failed. Way to put care before profit, insurers.)

I’m sure this has something to do with the drive-by increase.

But now comes the billion-dollar question.

Are Preventive Mastectomies Really Necessary?

No.

Hundreds of thousands of women (and some men) who will be diagnosed with breast cancer don’t need harmful, costly, and sometimes disfiguring interventions.

Why? Because up to 30 percent of all breast cancer diagnoses are for premalignant conditions. Prime examples are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).

These abnormal cells were undetectable until a few years ago. Today’s technology finds them easily. The problem is that many doctors order a biopsy, as well as treatment and removal, “just to be safe.”

But wait. What are the chances of DCIS becoming cancer at its worst?

About 20 percent.

And LCIS? It’s also non-malignant, and ranked 0 on a 0-to-4 threat scale.

But many doctors throw the book at these conditions anyway. Right up to prescribing a completely unnecessary mastectomy.

You know what’s less safe? The biopsies and surgery that can spread cancer cells elsewhere in the body, the radiation treatments that are known to cause cancer, and the wipe-out chemo that kills both helpful and harmful cells.

Watch their language

Many doctors agree with me that DCIS and LCIS, at least, should not be called “cancerous” or even “pre-cancerous.” Those words scare the heck out of people—in these cases, without justification.

Just as important, with DCIS, LCIS, and many other conditions, no intervention is indicated, let alone required.

It’s enough to keep a careful eye on those cells, and to make lifestyle changes that reduce your risk of future trouble.

If your diagnosis is early stage breast cancer, make sure your doctor isn’t using the C-word for DCIS or LCIS. If that’s not an issue, get a second opinion anyway.

Remember that even if DCIS and LCIS have been ruled out, your diagnosis is still not bulletproof. No single test is enough to launch an intervention as drastic as a biopsy, surgery, radiation, or chemo. Mammograms, for example, miss up to 20 percent of pathology warnings. So insist on having every additional test and consultation available:

• Thermography
• Ultrasound
• Full blood sugar panel
• Thyroid function
• Vitamin D sufficiency
• Vitamin A sufficiency
• Digestive system (biome) health and diet—consult with a qualified nutritionist

If all evidence indicates early stage breast cancer, it’s essential that you talk seriously with your doctor about the possible interventions, their possible or likely side effects, and what your best treatment options are, including possibly lumpectomy—targeted surgical removal of affected or vulnerable cells. This procedure has been proven as effective as mastectomy in preventing the spread of early-stage cancer.

How You Can Prevent Breast Cancer?

These aren’t going to prevent all cancers, but here are a few things you can do to lower your risk of cancer and other medical maladies:

• Get yourself on the Mediterranean diet, a proven cancer deterrent. Learn about it online, or your doctor or a nutritionist can advise. And add extra olive oil— women on the traditional Mediterranean diet who did so had a 68 percent lower risk of breast cancer.
• If you’re already physically active, ramp it up. If not, get active, even if it’s just a daily walk around the block.
• Be or remain socially and intellectually active. Good company and good conversation are the best medicine.

Take good care.

References

• Smith GL, Xu Y, Shih YC, et al. “Breast-conserving surgery in older patients with invasive breast cancer: current patterns of treatment across the United States.” J Am Coll Surg. 209(4):425-433.e2, 2009.
• Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. “Are mastectomy rates really increasing in the United States?” J Clin Oncol. 28(21):3437-41, 2010.
• Kummerow K, Du L, Penson D, et al. “Nationwide trends in mastectomy for early-stage breast cancer.” JAMA Surgery; Advance online publication 19 November 2014.
• The Dartmouth Atlas of Health Care. “Inpatient mastectomy for cancer.” http://www.dartmouthatlas.org, 2015.
• Breast Cancer.org. “Stages of Breast Cancer.” http://www.breastcancer.org/symptoms/diagnosis/staging
• US Deptartment of Health and Human Services, Agency For Healthcare Research and Quality (AHRQ). “Topic: Cancer: Breast Cancer.” http://www.ahrq.gov/health-care-information/topics/topic-breast-cancer.html

Last Updated: June 23, 2021
Originally Published: April 27, 2016