Sunday, February 28, 2010
Prophylactic Mastectomy? Study Shows Who Will Benefit
Do you remember your first bra? I remember wanting one, certainly, then walking up a large wooden staircase with my Mother to the second floor of Herman's department store in Marshalltown, Iowa. Herman's was on Main Street, naturally, and just a few steps from the courthouse, which stood deep in enormous, sheltering elms that were a hundred something years old at the time.
Once upstairs it was like we were on a stealth mission. My mother somehow signaled that mysterious Morse code mother speak to the sales clerk, who honest to God, had glasses on a chain and a cardigan sweater. I was to follow her, and she led us over to counter and removed two "training bras" (wrapped neatly in tissue paper) from a deep drawer packed with all kinds of equally wondrous garments.
Training? My breasts didn't need training God knows, they needed saving. Time will tell for sure but I believe that some protection from breast cancer can be put in place long before that first bra (yes, mine had a small pink bow) is worn for the first time. Exercise, the real old fashioned kind, the kind the guys do, is an essential component, as is a diet leaning far from the meat and potatoes of my Welsh/Irish parents and much closer to the mostly-vegetable-with-meat-once in a while that I enjoy now. Anything that smacks of hormones is to be avoided at all costs. I'm fairly certain my mother was given DES for miscarriage before I was born, a fairly common practice in the l950's. The CDC sites a study which points a significantly increased risk (of breast cancer) in DES daughters over age 40, but emphasizes that further research is needed to confirm this link. It's something I follow.
Between that first bra and l998 when my cancer was diagnosed, treatment for breast cancer evolved. Taxol. Tamoxifen. Taxotere. Herceptin. Biophosphonates. Breast conserving surgery. In l998 the thought of having both breasts removed to avoid the possibility of another cancer in the unaffected breast seemed unnecessary to me.
This is how I viewed treatment 1) surgery to get rid of the cancer 2) chemo to squash any nasty cells that decided to take up residence in my liver, brain, stomach or spine 3) radiation to prevent recurrence on the affected side and 4) tamoxifen to lower my estrogen level and trick any remaining hormone seeking cancer cells to consider themselves fed.
My type of breast cancer, an invasive lobular cancer, has a 20% chance of occurring in the other breast. Had. The way I looked at it; there was also an 80% chance that it wouldn't, and perhaps, with tamoxifen, even less. None of the physicians I talked with at the time -- including oncologists and a plastic surgeon, even mentioned a prophylactic mastectomy, yet another woman from my husband's office who was diagnosed within the same month with invasive lobular breast cancer did opt for a double mastectomy.
Between l998 and 2003: there was a 150% increase in CPM (contralateral prophylactic mastectomy) in the U.S., according to oncologist Isabelle Bedrosian, M.D, from The University of Texas M.D. Anderson Cancer Center. Now oncologists will be able to provide women trying to make this difficult decision with results from the first population-based study.
Published in the Journal of the National Cancer Institute last week, researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, which now represents 26 of the U.S. population. From that group, there were 107, 106 breast cancer patients who underwent mastectomy and 8,902 who of those had the unaffected breast removed as well.
What the researchers found: "a clear survival benefit" for women under fifty with early stage (Stage I or II) disease that is hormone or ER negative.
The researchers also found that CPM was not beneficial for women over 60, and that any benefit for younger women with early stage estrogen-receptor positive cancer was still not clear. This study also excludes the subset of women whose cancer is positive for BRAC mutations. This is a different subject entirely.
Let's keep working for ways to keep all of us, our sisters, our mothers, our friends, our daughters, free from cancer. For today, at least, we have another bit of information to keep in our arsenals should this agonizing decision become one we need to consider.
Please, by all means, read about this study. Its good to know: