Study: Are more men with breast cancer opting for prophylactic mastectomy?
|At a glance||Questions for your doctor|
|What does this mean for me?||Limitations|
This study is about:
What are the factors that lead men with breast cancer in one breast to choose to undergo double mastectomy.
Why is this study important?
Researchers have seen the rates of double mastectomy increase in women with breast cancer but they do not know if this increase is also true for men.
- The rate of prophylactic mastectomy doubled (from 3% to 6%), but the overall number is still very small, with only 106 of 1884 men with invasive cancer in one breast choosing to undergo double mastectomy.
- The factors associated with a higher likelihood of double mastectomy include: younger age, white race, and having private insurance rather than Medicaid.
This study indicates an increase in the rate of men choosing double mastectomy between 2004-2005 and 2010-2011. However, it is important to note that most men with breast cancer have a unilateral mastectomy (approximately 75% of men in 2004-2005 and 2010-2011 chose this option). The decision to undergo a single or double mastectomy should be a personal, individual one, made in consultation with your healthcare provider.
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Firger, J. “Rise Seen in Preventative Mastectomy for Male Breast Cancer Patients.” Newsweek. Published September 2, 2015.
Jemal A, Lin C, DeSantis C et al. “Temporal Trends in and Factors Associated with Contralateral Prophylatic Mastectomy Among US Men With Breast Cancer.”
Tai YC, Domchek S, Parmigiani G, et al. “Breast cancer risk among male and mutation carriers.” J Natl Cancer Inst. 99(23): 1811-4, December 5, 2007.
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
Researchers have noted increased rates of double mastectomy in women diagnosed with invasive cancer in one breast. This trend is especially true for younger women. Factors that researchers believe contribute to the increased rates of double mastectomy include:
- increased testing
- use of (some research suggests findings cause patients to worry about cancer developing in the opposite breast)
- the desire to achieve symmetry through reconstructive surgery
Although more women are opting to undergo double mastectomy – which comes with a risk of complications and costs – studies have not shown a survival benefit from the surgery. Unlike women, the double mastectomy rates among men with cancer in one breast and the various factors that contribute to their decisions are unknown.
Researchers of this study wanted to know:
Whether the double mastectomy rate in men has increased.
Population(s) looked at in the study:
6332 men who:
- Were at least 20 years old
- Had been diagnosed with I-III invasive breast cancer in one breast
- Underwent surgery between 2004 and 2011
- Comparing the double mastectomy rates during 2004-2005 to 2010-2011 indicates that the rate of this surgery increased from 3% to approximately 6%.
- 35 of 1166 men with invasive cancer in one breast chose to undergo double mastectomy in 2004-2005 while 106 of 1884 men with invasive cancer in one breast chose to undergo double mastectomy in 2010-2011
- The factors that were associated with a higher likelihood of double mastectomy were:
- younger age
- white race
- having private insurance rather than Medicaid.
The researchers note that studies have found that increased testing has increased prophylactic mastectomy rates in women with breast cancer. This research was not able to look at the status of those in the study population. However, because male breast cancer is linked to , and other inherited mutations, it is possible that a sizable number of study participants may have been found to be mutation carriers.
According to study author Dr. Ahmedin Jemal, quoted in a Newsweek, article, “it’s important for male patients to ask a physician about their individual risk for before making any decisions about the surgery…It’s only the patients at high risk who are likely to benefit from the procedure.”
Although not as much research has been done on men with breast cancer, we do know that those with a mutation have a 7% risk of developing breast cancer by age 70. No studies, however, look at the risk of a second breast cancer diagnosis in men with mutations. By looking only at male survival rates and failing to also look at recurrence rates, researchers are unable to consider the possibility that double mastectomy may be decreasing the occurrence of a second cancer, helping these patients avoid further treatment.
In women without a mutation, the chance of a second breast cancer diagnosis 10 years after the initial diagnosis is approximately 10%. The risk is 10%-30% for breast cancer survivors with a mutation.
Additionally, it is important to note that the researchers were able to see a significant difference in the rate of double mastectomy only between the years 2004-2005 and 2010-2011. They were unable to see any significant differences when comparing rates in 2004-2005 to those in 2006-2007 or in 2008-2009. Although the lack of a rate increase between 2006 and 2009 may strengthen the researchers’ argument that the increased rate of double mastectomy is, in fact, new, more data needs to be collected to ensure the trend is stable rather than something unique to 2010 and 2011.
For both men and women, the decision to undergo a prophylactic mastectomy should be an individual, personal one, made by patients in consultation with their healthcare providers. Although the data from this study indicate the rates of this surgery in men with breast cancer have increased, more research is needed, both to understand why the rates have increased and to determine if there is a subset of men who will benefit from the procedure.
The National Comprehensive Cancer Network (NCCN) has a panel of experts who address male breast cancer in their breast cancer treatment guidelines.
- The NCCN panel points out that few clinical trials have focused on men with breast cancer, and treatment recommendations for men are taken from findings from research involving only women. Therefore, many of the recommendations for the treatment of male breast cancer are similar to treatment in women, including:
- sentinel lymph node biopsy
- radiation therapy
- Oncotype Dx
- The panel highlights the following considerations for male breast cancer:
- All men with breast cancer should be referred for genetic counseling and testing.
- Although men with breast cancer were previously recommended to undergo mastectomy, emerging data suggest that breast-conservation therapy for men may be as safe and effective as mastectomy.
For ER receptor-positive cancers, hormone therapy options include tamoxifen or a GnRH analog plus an aromatase inhibitor. Aromatase inhibitors used alone (without a GnRH analog medication) have resulted in worse outcomes than tamoxifen alone in men. Men who receive GnRH analogs and aromatase inhibitors should have their bone density checked.
- What are the pros and cons of mastectomy vs. ?
- What are the costs and complications that can be associated with double mastectomy?
- Is an option?
- As a man with breast cancer, should I consider genetic counseling and/or genetic testing?
- A male blood relative has had breast cancer, should I be concerned that it is hereditary?
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
Who covered this study?
Rise Seen in Preventive Mastectomy for Male Breast Cancer Patients This article rates 4.5 out of 5 stars
Double Mastectomies for Men with Breast Cancer on the Rise This article rates 3.5 out of 5 stars
More Men With Breast Cancer Opting for Double Mastectomies This article rates 3.5 out of 5 stars
The Angelina Jolie Effect: Prophylactic Surgeries Nearly Double in Men With Breast Cancer This article rates 2.0 out of 5 stars
The Market Business
Double Mastectomy is an Answer for Most Male Breast Cancer Patients This article rates 1.5 out of 5 stars