I can still recall the day when, at 8 years old, I learned that my grandmother had breast cancer. She'd come to our house for a visit using a yardstick as a cane because it was so painful for her to walk. (We found out later that the malignancy had already spread to her bones.) After my father pressed his mother for an explanation, she finally revealed that she'd had a breast lump for years but was too afraid to see a doctor, so reluctant was she to face the disease that had killed her two sisters and go through the harrowing radical mastectomy. This was 1978. Thirty years later, the vast majority of breast cancer patients can be spared from disfiguring surgery. Yet many women with small tumors that haven't spread choose to have their breast removed, even when breast-conserving surgery offers the same survival chances.
The National Institutes of Health has for nearly 20 years recommended lumpectomy plus radiation for early breast cancer, but the United States has the highest rate of mastectomies among 21 industrialized countries. And a recent study found a 150 percent increase between 1998 and 2003 in the number of women opting to have both breasts removed when cancer is found in one; this is an overly aggressive approach, say University of Minnesota researchers, since most breast cancer patients never develop a tumor in their other breast. To learn why some women are opting out of kinder, gentler surgeries, researchers from the Georgia Institute of Technology in a study published yesterday interviewed 12 who chose mastectomies against their doctor's advice; they found that fear trumps statistical risk models when it comes to making treatment decisions. Many of the women felt in their gut that more must be better, that removing the breast must stamp out cancer more effectively than extracting just the lump.
When it comes to preventing breast cancer, the same may apply: Breast surgeons are performing an increasing number of prophylactic mastectomies as more women get screened for breast cancer gene mutations. While this approach does appear to drastically lower a woman's future breast cancer risk, a new study appearing in today's Journal of the American Medical Association shows that women who carry a mutation in their BRCA1 or BRCA2 genes have a chance of somewhere from 40 to 51 percent of developing breast cancer by age 70—not the previously cited risk of 50 to 80 percent. That might give some BRCA mutation carriers pause. Perhaps frequent breast screenings could be an option, after all. There's no question that while more women die of heart disease, breast cancer is the stuff of our nightmares. It invokes the kind of fear that paralyzed my grandmother—and leads women to choose an A-bomb treatment when a Patriot missile would be just as effective.