The number of men with invasive cancer in one breast who undergo surgery to remove both breasts is on the rise, according to a new report published in JAMA Surgery.
The report, written by researchers from the American Cancer Society and the Dana-Farber Cancer Institute, is the first to establish this trend, which mirrors a rise in the amount of U.S women also having the surgery for unilateral breast cancer over the last 20 years. However, researchers say there is a lack of evidence to support any survival benefit as a result of having both the affected and unaffected breasts removed.
Lead author of the study Ahmedin Jemal, American Cancer Society, said:
The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care.”
Previous studies have shown a significant increase in the number of contralateral prophylactic mastectomy (CPM) procedures to remove both breasts in cases where women have invasive cancer in one breast. In 1998, about 2.2% of these women underwent the surgery, but this figure rose to 11% in 2011. However, it is unknown whether the use of CPM to treat male breast cancer, which accounts for around 1% of all breast cancer cases, is also increasing.
To explore whether this is the case, Jemal and colleagues looked into the treatment received by 6,332 men who underwent surgery for unilateral invasive breast cancer between 2004 and 2011. The team used nationwide data from the North American Association of Central Cancer Registries to examine the temporal trends in and factors associated with the use of CPM among the study population.
The results showed that the rates of CPM almost doubled between 2004 and 2011, from 3.0% to 5.6%. Further analysis showed that the sociodemographic factors associated with the increase were being white, younger age and having private insurance – the same factors that are linked to an increased use of CPM among women.
Health care providers should be aware that the increase we’ve seen in removal of the unaffected breast is not limited to women. Doctors should carefully discuss with their male patients the benefits, harms, and costs of this surgery to help patients make informed decisions about their treatments,”