S ignificant advances in diagnosis and treatment mean that we now find far more breast cancers at early stages when they’re highly curable. However, in a surprising trend, more women are opting for very aggressive treatment -- double mastectomy -- rather than breast-conserving surgery and radiation. That’s what researchers from the University of Minnesota School of Public Health discovered in a recent study.

Acknowledging that the decision-making process is extremely complex, study coauthor Beth Virnig, PhD, MPH, a professor at the university, said it’s important for every patient to keep in mind that while just removing the breasts may seem to solve the problem of spread and recurrence, major surgeries also bring greater risk for complications and a longer recovery time. And, in fact, many women may not realize how many surgeries -- and the associated time and discomfort involved in recovering from them -- are required for reconstruction.

RESEARCH FINDINGS

One in five new breast cancer cases is "ductal carcinoma in situ," or DCIS, a form that is highly curable. Dr. Virnig and her colleagues used the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database to identify more than 51,000 women who had either lumpectomy or mastectomy for DCIS between 1998 and 2005. Of that group, 30.1% underwent mastectomy after DCIS was found in one breast -- of these, 13.5% had both breasts removed. The percentage of women undergoing mastectomy who chose this aggressive approach nearly tripled over the course of the study period, rising from 6.4% to 18.4%.

In DCIS, cancer cells remain contained within a single duct and have not yet spread into surrounding fatty breast tissue. The 10-year breast cancer survival rate for women with DCIS is 98% to 99%, and the risk of developing breast cancer in the opposite breast is low, but it does increase over time -- from 3.3% at five years to 10.6% at 20 years. Younger women, in particular, may be taking this increased risk into account when opting for double mastectomy after being diagnosed with DCIS in one breast, notes Dr. Virnig, who adds that fear of breast cancer recurrence plays a major role in decision-making. Also, breast reconstruction has improved in recent years, which may be a factor in the decision.

Results of the research were published in the March 20, 2009, issue of Journal of Clinical Oncology.

Women with DCIS who choose treatment in the form of lumpectomy and radiation have an excellent prognosis, but every woman must weigh her own priorities and fears. There are no right or wrong decisions. If you are diagnosed with DCIS, ask your doctor to clearly delineate the pros and cons of all your treatment options. Factors to consider include whether or not you have an abnormal BRCA1 or BRCA2 gene, which increases risk... your age (in the study, younger women were more likely to choose double mastectomy)... family history of breast cancer... and the size of your tumor, which may have an impact on reconstruction options. You even may want to seek several opinions to make sure that you get a balanced understanding of all options before coming to a decision.