After reading Alison’s excellent blog entry regarding the efficacy of self-exams at detecting breast cancer, I’ve been thinking more about women’s choices regarding both prevention, as well as treatment, for breast cancer. I think Christina Applegate’s decision to have a mastectomy to treat her breast cancer really surprised me; it seemed such a drastic choice for a young, seemingly healthy woman, especially one who makes a living based partly on her physical appearance.

I found a study, published in the Journal of Clinical Oncology (full article can be read for free here)  that found that women who were most involved in their treatment decisions were more likely to choose mastectomy over a breast conserving surgery. This is slightly counter to the charges I’ve heard lain at physicians doors: namely that they’re responsible for increasingly invasive, and sometimes unnecessary, procedures. The study insists instead, that women are so frightened of disease recurrence that they would rather lose both breasts rather than face the possibility of the disease coming back.

That choice still seems rather odd to me, especially since, according to the American Cancer Society, white women have a 91% 5-year survival rate for breast cancer, higher than any other cancer studied (African American women have a 78% rate, which is still higher than other cancers for this group). One possible reason for the results about mastectomy choice is that the researchers used women with an average age of 60. I don’t want to sound ageist, but it seems likely that women at that age could have fewer conflicts with the idea of a mastectomy than their younger counterparts, who may still be considering childbirth and breastfeeding.

What do you guys think? Under which conditions would opt for a complete mastectomy over a more conservative option? Does knowing the high probability of surviving the disease influence your decision?



I can understand the "better to be safe than sorry" mentality, but I'm with Lara - if it wasn't a late-stage cancer, I would opt for a lumpectomy. No matter how mentally strong I think I could be, and how cancer-free I would be as a result, I think that a mastectomy would have more dire consequences on my identity as a woman than I would admit to myself before the procedure.

I think that I would definitely choose a lumpectomy over mastectomy in most situations. I would only have a mastectomy in the case of later stage cancer. My mother had breast cancer and was advised that her survival rate would be about the same with a lumpectomy, radiation and chemotherapy as with complete removal of the breast. She was in her early 50s opted for lumpectomy. At the age of 63 she is still cancer free.

I have a stage 2 thyroid cancer. And haven't had the chance to undergo medication, for financial reason. I just want to ask, is there any chance that this would lead to complicate other disease like breast cancer? Just a thought.

Interesting to get to understand the psychology of the event - and the fear of re-occurrence. The sad thing is that there is little done to proactively manage this - sure there is some counseling available post-procedure, but we generally ignore the mental health issues - sad

A lot of women fear the re-ocurrence of the disease which is understandable. However, there are certain things we can do to make the chances of it happening again very minute. Changes to your diet and to your lifestyle will already go a long way to ensure that you will stay cancer free for life.

The efficacy of self-exams at detecting breast cancer, this idea can save lots of lives, a good friend of mine found out she had cancer by doing the exam herself and had to have a mastectomy....

My mom had breast cancer and was advised that her survival rate would be higher with a lumpectomy, radiation and chemotherapy as with complete removal of the breast. She was in her early 60s opted for lumpectomy.

It goes without saying that preventative measures should constantly be reinforced throughout our lives. Regarding actual treatment plans: I would think and recommend that the most conservative option be taken at any given moment. This "conservative option" is a relative term in light of the objective facts. Fear should not be the primary catalyst for a decision, although it most often is in all aspects of life. Addressing cancer in this blog post, unless aggressive and in a high risk critical category, accurate education and awareness needs to be promoted, all viable options need to be thoroughly and objectively explored (from nutrition to radical procedure), and health counseling and support groups need to be sought BEFORE undergoing radical procedures. This is the only way an individual can be truly informed and make decisions with eyes wide open. Ultimately, it is recognized that any decision is not easy and the final choice is up to the patient. Adverse outcomes breed a plethora of second guesses. **Personal note** My wife died of a grade IV astrocytoma brain tumor (glialsarcoma)in Jan '98. She was 28 yoa. From diagnosis to death was 3 months. She died of post surgical complications from the second radical surgery. The hospital and doctors were excellent and I appreciate their efforts. However, I occasionally wonder and reflect if we rushed the surgeries without thoroughly exhausting other options and cutting edge conservative procedures.

Breast cancer runs in my family, but so far, I've been okay. But, the thought of what I would do if I had to have a mastectomy flirts in and out of my thoughts. I've even wondered if I would have one, should I get breast cancer, just to be assured of getting rid of it. My thoughts go out to all the brave women (and men) who've had to deal with this issue.

I had my breast removed 4 years ago as I didn't have much choice. I think it is case by case basis on whether or not it is a good decision. It depends on how quickly you find the cancer I suppose.

My wife was recently diagnosed with breast cancer, and I've been doing a lot of reading lately. Thanks for the article... I just want to know more about what's going on these days.

I agree with Dr. David here. We must educate ourselves and seek out support groups before we make any decision into our treatment. Personally, i would like to go through conservative treatments first, if ever I am diagnosed at an early stage. I also have a history of breast cancer. The thought of losing my breasts scares me, as other commenters said, it is a major part in our identity as a woman. But there are lots of those who have already gone through the procedure, and we all know that they are not less of a woman than me or others.

I also agree that self-education will should be mandatory before heading into treatment. Being struck by this, I know what someone needs to go through, and this might can be lowered by early detection.

I had breast cancer and highly recommend reading the information at Did you know that you everybody gets cancer cells? Your body's own immune system is able to combat it. If you have a strong immune system, your body will never allow cancer to grow to the point of harming you. You have the power to heal yourself. The cures to cancer are just ways to boost your immune system, expunge toxins and stop feeding the cancer with pollutants

Having a breast cancer is really a tough one and you never know when your completely safe of it so I understand why some want to do mastectomy.

I am 43 and as of yet have not had to personally make such a decision. My sister however, has. She is a breast cancer survivor for 7 yrs. now. She was 52 when officially diagnosed...I say officially because for the prior 10 years, she had gone religiously to get her annual exam and for 10 years there it was on the x-ray but she was always told, "It's normal, nothing to worry about." Until moving and seeing a new physician. I am so bitter at the thought that she could have been a victim due to negligence that I do not trust any in the medical field. She did choose a full mastectomy and for now it has been the right choice. However, the emotional side of a mastectomy is never spoken about. It is a loss. If I had to choose, I would most likely choose a mastectomy. I would just want to get it over with!

Breast cancer is a very serious disease.People must become concious about cancer.It is a cultural thing about woman not touching themselves.