When actress Angelina Jolie revealed last week in the New York Times that she had a double mastectomy to prevent breast cancer, media outlets across the country interviewed doctors, breast cancer patients, and generally added their two cents to the discussion about whether this type of surgery is worthwhile.
Jolie has a history of breast cancer in her family. Her mother died of the disease at age 56. And she carries the gene that increases her risk of developing breast and ovarian cancer. Still, I wondered, what does the evidence say about breast removal surgery to prevent cancer?
It turns out, there is some good evidence about prophylactic mastectomies. The Cochrane Collaboration published a comprehensive review in 2010 to determine whether the surgery reduces death rates in women who have never had breast cancer and in women who have a history of breast cancer in one breast. It also examined the incidence of breast cancer in women who undergo the surgery and the psychological effects of the procedure.
The review includes the results of 39 observational studies and a total of more than 7,000 patients who underwent preventative mastectomies. It found that surgery was effective in reducing the incidence of breast cancer and improving survival in women with high breast cancer risk.
But the procedure has some downsides. Most women in the review are satisfied with their decision to have the surgery, but less satisfied with the cosmetic results of breast reconstruction. Most women worried less about developing breast cancer, although researchers noted they might have overestimated their own chances of developing the disease.
In patients who developed cancer in one breast, removing the other breast was found to reduce the incidence of cancer in that breast, but there was not enough evidence to show that surgery improves overall survival rates.
The authors noted a major limitation of the review: it only included observational studies. To better understand this important issue, medical researchers need to conduct randomized clinical trials. Providing as much evidence-based information as possible to women is the best way to empower them to make the best choice for themselves.
Speak Your Mind