Jolie's Double Mastectomy May Be Overused, Experts Say

Rachel Joy Horn's breasts were ticking time bombs. She lost trust in her body and no longer felt comfortable in her own skin.

This is how she felt, she said, when her doctor broke the news to her that she'd tested positive for a gene mutation that put her in the high-risk category for developing breast cancer. So at the age of 21, Horn chose to undergo double-mastectomy surgery to remove both her breasts and, hopefully, the future threat of cancer.

"By the time I was tested, my mom had gone through breast cancer twice so I already had it in my mind that surgery was a possibility for me," the Los Angeles woman, now 23, said.

Horn is certainly not alone in her decision. Stars like actress Christina Applegate, talk-show host Sharon Osborne and, most recently, Oscar-winner Angelina Jolie have revealed that they, too, have chosen to preemptively removed their breasts because of a strong genetic predisposition for breast cancer.

Jolie's Double Mastectomy Decision for Kids

It sounds like an extreme choice but a woman who has inherited a harmful mutation of either the BRCA1 or BRCA2 gene is about five times more likely than average to develop breast cancer and up to 40 percent more likely to develop ovarian cancer, according to the National Cancer Institute. Experts increasingly believe that removing as much breast tissue as possible can be a lifesaving strategy.

As Dr. Mehra Golshan, director of Breast Surgical Services at the Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston explained it, "For women who know in advance there is a good chance they will develop breast cancer sooner or later, having prophylactic surgery can make sense. It lowers the risk of developing cancer by more than 90 percent."

In one recent study that followed nearly 2,500 women who carried one of the two dangerous gene variants, having a double mastectomy did appear to lower their risk of breast cancer. None of the women who opted to have their breasts or ovaries removed were diagnosed with breast cancer in the three decades they were followed, while 7 percent of those who chose not to have surgery were.

Horn said that removing her breasts gave her the sense that she had dodged a bullet.

"I remember waking up after surgery and feeling groggy but happy," she recalled. "I immediately felt relieved that I no longer had this cancer diagnosis hanging over my head."

Angelina Jolie's Mastectomy: What You Should Know

But even though the data show a preemptive strike against breast cancer can improve the chances of survival in women with inherited risk, some medical experts are concerned that instead of fighting to save their breasts as they did in the past, many women are choosing to remove them at the slightest whiff of cancer.

The Journal of Clinical Oncology reported a 188 percent jump in the surgery between 1998 and 2005 among women given a new diagnosis in one breast of ductal carcinoma in situ, or DCIS, the "stage zero" cancer. Among women with early-stage invasive disease, the rates soared more than 150 percent.

"Many women choose to have other breast removed to avoid the trauma of going through breast cancer again even though, in reality, the chances of reoccurrence are very low," said Dr. Julian Kim, chief, of oncologic surgery at the UH Seidman Cancer Center in Cleveland.

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Surgical Breast Biopsies Being Overused

A study conducted in Florida suggests that too many women are undergoing open, surgical breast biopsies instead of less invasive needle biopsies. These results were published in the American Journal of Surgery.

If a woman has a breast lump or an abnormal area of the breast seen by breast imaging, a sample of breast tissue may be removed for further evaluation. This is called a breast biopsy. Tissue may be removed through a needle, or in a more extensive procedure known as an open, surgical biopsy. Needle biopsies are a less invasive procedure and are preferred for most women.?

To explore the frequency of needle and surgical breast biopsies, researchers collected information about biopsies performed in Florida between 2003 and 2008.????

Although use of needle biopsies increased over the time period of the study, the overall rate of surgical biopsies remained high. An estimated 30% of breast biopsies involved open, surgical biopsy. The researchers note that if surgical breast biopsies were used in only 10% of all breast biopsies (a reasonable goal), it would save money and allow many women to avoid unnecessary surgery. A majority of women who undergo breast biopsy do not have breast cancer.?

The reasons for the high rates of open, surgical breast biopsy are uncertain.

Women who need a breast biopsy should talk with their physician about the type of biopsy that will be performed. A surgical biopsy may be required for some women, but many women will be candidates for a less invasive needle biopsy.

Reference: Gutwein LG, Ang DN, Liu H et al. Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions. American Journal of Surgery. Early online publication February 8, 2011.

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