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Bilateral Mastectomies: a patient’s personal decision

Claire L. Buchanan, MD, FACS

Claire L. Buchanan, MD, FACS
Breast Cancer Surgeon

Last week the Seattle Times reported that women diagnosed with early stage breast cancer in one breast are choosing to have bilateral mastectomies to reduce their chances of getting cancer again, but recent research shows that that there is no survival benefit, even in younger women. Researchers at Stanford and the Cancer Prevention Institute of California evaluated the outcomes of over 190,000 women from the California Cancer registry who were diagnosed with breast cancer in one breast between 1998 and 2011. The rate of bilateral mastectomies rose from 2% to 12.3% over the study period, yet there was no survival benefit to bilateral mastectomies versus lumpectomy and radiation.

To those of us who work in the field, this data comes as no surprise; the trend of bilateral mastectomies is a known phenomenon. More than 10 years ago, I remember the chatter among surgeons at national meetings asking if others noticed that more and more, younger women were coming in asking for bilateral mastectomies. Back in 2007, Dr. Todd Tuttle authored a study in the Journal of Clinical Oncology that found that the rate of contralateral prophylactic mastectomy was on the rise, from just under 2% in 1998 to 5% in 2003. This week’s study only validates that this upward trend shows no sign of leveling off.

Why do patients choose bilateral mastectomies?

Many women ....

BRCA Genetic Testing for Hereditary Breast and Ovarian Cancer

Robert Resta

Robert Resta
Genetic Counselor

In today’s New York Times, actress and director Angelina Jolie bravely and openly discusses her experience with BRCA genetic testing for hereditary breast and ovarian cancer:

The 37 year old Ms. Jolie – who has not had cancer – underwent genetic testing because of her family history of cancer. She was found to carry a mutation in the BRCA1 gene, which puts her at significant risk of developing breast and ovarian cancers. Ms. Jolie, the mother of 3 adopted and 3 biological children, elected to undergo a risk-reducing double mastectomy, and plans to have her ovaries and fallopian tubes removed soon to lower her risk of developing ovarian cancer.

Ms. Jolie’s story opens a public conversation about the importance of genetic testing in helping to reduce a woman’s risk of developing breast and ovarian cancers. This very personal decision about mastectomy by someone widely regarded as one of the most beautiful women in the movies also helps women recognize that their body image and sexuality does not have to be defined by their breasts. Not every woman will make the decision to have major surgery, but genetic test results can also make sure that your breast cancer screening is appropriate for your level of risk; women who carry a BRCA gene mutation need ...

Misconceptions & Misunderstandings About Genetic Testing For Hereditary Cancer: Don’t Test Me, Test My Family!

Robert Resta

Robert Resta
Genetic Counselor

As a genetic counselor with 30 years of experience, I have met with many families who have been concerned about their hereditary risks to develop cancer and other disorders. I have found that the complexity of genetics can sometimes cause misunderstandings about some critical information.

A common question that patients ask is this: I already have cancer, it makes no sense for me to have genetic testing, so why don’t you test my family instead?

As it turns out, the best strategy for most families is to for genetic testing to start with a relative who has already been diagnosed with cancer.

  1. If that person has a normal genetic test result, there is usually no need to test any other healthy family members.
  2. Because of the complicated nature of cancer genetics, accurate interpretation of a negative result usually requires an affected relative to have a positive genetic test.
  3. If a patient has a positive genetic test, the cost of testing all other family members will usually be considerably less expensive and increases the likelihood that health insurers will cover the test.

Let’s clarify this with a specific example.

Three sisters, all in their 30s, want to undergo genetic testing because their mother is a breast cancer survivor, and ...

Swedish Set to Open Comprehensive True Family Women’s Cancer Center

Swedish News

SEATTLE – May 29, 2012 – Swedish Cancer Institute (SCI) is set to open its new True Family Women’s Cancer Center to patients on Tuesday, June 5. Carefully designed with the female cancer patient in mind, the new 23,600-square-foot women’s cancer center gives Swedish Cancer Institute the ability to consolidate most of its services for treating women’s cancers into one facility. The new center acts as a treatment hub where women are guided through personalized and coordinated multidisciplinary treatment of their cancer, including disease-specific education and holistic support activities.

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