Women with breast cancer gene mutation more likely to survive cancer after double mastectomy

February 11, 2014, British Medical Journal

Women who carry a mutation on the BRCA breast cancer gene - and are diagnosed with early stage breast cancer - are significantly less likely to die if they undergo a double mastectomy than those who have only one breast removed, suggests a paper published in BMJ today.

The authors say should be discussed as an option for with a BRCA mutation and early onset . However, given the small number of women in this group, further research is required to confirm the findings.

Women who carry a BRCA1 or BRCA2 gene mutation face a lifetime risk of breast cancer of 60 – 70% and once diagnosed with breast cancer face a high risk of second primary breast cancer. There is little information on the long-term survival experience of women with either of these genes who are treated for breast cancer.

In North America, one half of women with a BRCA mutation will undergo a double breast removal to prevent a second breast cancer, but it has not yet been shown that this reduces the risk of death.

Researchers from the US and Canada set out to review the twenty year survival experience of 390 women (from 290 different families) with early-stage breast cancer, diagnosed from 1975 to 2009. The women were either known to be carriers or were likely to be carriers of the BRCA1 or BRCA2 gene and were treated with single or double mastectomy.

Of these 390 patients, 44 were initially treated with bilateral (double) mastectomy and 346 were initially treated with unilateral (single) mastectomy.

Of those that were treated with unilateral mastectomy, 137 went on to have the other breast removed at a later date (contralateral mastectomy). The average time from diagnosis to contralateral mastectomy was two years.

Over the 20 year follow-up period, 79 women died of breast cancer (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group).

Results showed that having both breasts removed was associated with a significant (48%) reduction in breast cancer death compared with having only one breast removed over a 20 year period.

Based on these results, the researchers predict that of 100 women treated with double mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with single mastectomy.

The authors say bilateral mastectomy should be discussed as an option for young women with a BRCA mutation and early onset breast cancer. However, given the small number of women in this group, further research is required to confirm the findings.

The significant mortality benefit associated with a double breast removal was most apparent in the second decade of follow-up after initial breast cancer diagnosis. The majority of deaths during this time period (55%) occurred among women who experienced a second breast cancer.

The researchers conclude that it is "reasonable to propose bilateral mastectomy as the initial treatment option for a woman with early-stage breast cancer who carries a BRCA1 or BRCA2 mutation". They suggest further discussion with women who have previously had one breast removed. They also suggest that women with newly-diagnosed breast cancer might benefit from knowing they carry a BRCA mutation.

In an accompanying editorial, Dr Karin Michels, from Harvard Medical School, says that carriers of a mutation in the BRCA1/2 gene who develop breast cancer face a similar decision to that of Angelina Jolie, who recently underwent a double preventative mastectomy.

Dr Michels says that although Metcalfe's study suggests a significant reduction in breast cancer related deaths with a double mastectomy, "larger studies tackling this issue are needed and will undoubtedly be generated in the years to come". She adds that breasts are an "essential part of 's identity, sexuality, and self perception" and that no statistics can make the decision on whether a woman will opt to undergo a double mastectomy.

Explore further: Growing use of MRIs leading to more invasive breast cancer surgery

More information: Paper: Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis, BMJ, 2014.

Editorial: Contralateral mastectomy for women with hereditary breast cancer, BMJ, 2014.

Related Stories

Growing use of MRIs leading to more invasive breast cancer surgery

August 14, 2013
Heavy use of magnetic resonance imaging (MRI) may be leading to unnecessary breast removal in older women with breast cancer, according to a study by Yale School of Medicine researchers in the current issue of Breast Cancer ...

Contralateral prophylactic mastectomy may not significantly increase life expectancy

October 7, 2013
Women with early-stage breast cancer in one breast are increasingly opting to undergo a more aggressive operation to remove both breasts called contralateral prophylactic mastectomy (CPM). Rates of double mastectomies have ...

Drug offers prevention hope for women with BRCA breast cancer gene

August 6, 2013
Use of the anti-cancer drug Tamoxifen is associated with a dramatically reduced risk of developing a second breast tumour among women with a high risk gene mutation who have experienced breast cancer already, a new study ...

Most women who have double mastectomy don't need it, study finds

November 27, 2012
About 70 percent of women who have both breasts removed following a breast cancer diagnosis do so despite a very low risk of facing cancer in the healthy breast, new research from the University of Michigan Comprehensive ...

Largest ever study of male breast cancer treatment shows more mastectomy, less radiation than in female disease

October 31, 2013
University of Colorado Cancer Center researchers used data from 4,276 cases of male breast cancer and 718,587 cases of female breast cancer to show that the disease is treated differently in men than in women. Specifically, ...

More women consider gene test after Angelina Jolie mastectomy revelation

August 14, 2013
(HealthDay)—After hearing about film star Angelina Jolie's double mastectomy, a growing number of U.S. women now say they may ask their doctors whether the same preventive measure is right for them, according to a new Harris ...

Recommended for you

Cancer patients who tell their life story find more peace, less depression

January 22, 2018
Fifteen years ago, University of Wisconsin–Madison researcher Meg Wise began interviewing cancer patients nearing the end of life about how they were living with their diagnosis. She was surprised to find that many asked ...

Single blood test screens for eight cancer types

January 18, 2018
Johns Hopkins Kimmel Cancer Center researchers developed a single blood test that screens for eight common cancer types and helps identify the location of the cancer.

Researchers find a way to 'starve' cancer

January 18, 2018
Researchers at Vanderbilt University Medical Center (VUMC) have demonstrated for the first time that it is possible to starve a tumor and stop its growth with a newly discovered small compound that blocks uptake of the vital ...

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.