Prophylactic mastectomy: the latest craze?

Recently, the New York times published an article about the growing number of women who are choosing to have bilateral mastectomies as a means of preventing breast cancer.

There seems to be a growing disconnect between the media, the medical community, and the women they serve on this topic.  Perhaps it is just my imagination, but there is something left unstated in the growing number of articles that reflect on preventative mastectomies as a fad or the ‘latest craze.’  There is something bothersome about how women in these articles are portrayed in contrast to the medical experts who are interviewed.  Here is an example in the New York Times article:

“You’re not going to find other organs that people cut out of their bodies because they’re worried about disease,” said the medical historian Dr. Barron H. Lerner, author of “The Breast Cancer Wars” (2001). “Because breast cancer is a disease that is so emotionally charged and gets so much attention, I think at times women feel almost obligated to be as proactive as possible — that’s the culture of breast cancer.”

I couldn’t quite put my finger on it what bothered me about the slant of this article…so I had to run around and scream for a while while ripping out my hair.  And then it hit me.  It seems that the New York Times and certain doctors within the medical community have started to believe that female hysteria is causing this so-called ‘mastectomy epidemic.’

Hysteria

Yes doctor! The reason I am cutting off my breasts is…hysteria!!

For women like me, the decision to have a mastectomy was very clear.  It was a logical choice, even if I lived in fear of breast cancer.  But for most women who do not carry a BRCA gene mutation, the decision to have a bilateral mastectomy has been deemed inappropriate, because the risk factors aren’t clear.

Certainly there is a lot of evidence out pointing to the facts about survival and outcomes of women who opt for mastectomies.  For women who carry BRCA mutations, overall chances of mortality are reduced.  And for women who do not carry a genetic predisposition to breast cancer, there is complex decision-making process that happens – weighing pros and cons of contralateral prophylactic mastectomies versus lumpectomy procedures.

Do we do a disservice to women who are faced with these decisions when we focus solely on mortality reduction?  Isn’t there more to a decision than choosing to reduce mortality – like deciding whether to have radiation, peace of mind that mammography is no longer needed after surgery?

The question remains:  what is fear of the medical community when an increasing number of women opt for prophylactic or contralateral prophylactic mastectomies?  Why do we have to frame this these articles in terms that make women look hysterical and stupid?

Let’s not confuse a woman’s fear of breast cancer with her ability to make a rational and personal decision about her health.  Can we not give women an accurate picture of the pros and cons, and allow her to make informed decisions based on what she thinks is most important?  I think need to empower patients to understand their options and make decisions based on the best information available.  I take issue with judgmental comments from the medical community, because a doctor’s role is to provide the information and criteria for a woman to decide what she wants to do about her health.

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