Celebrities including Angelina Jolie, Giuliana Rancic, and Christina Applegate have been vocal about choosing mastectomy (breast removal) to treat or prevent breast cancer. American women have also increasingly opted for mastectomy, with the rates of the procedure increasing by more than one-third in the past two decades, according to a 2014 study.
A large new U.S. study shows that this popular breast cancer treatment option, when combined with breast reconstruction, carries a high risk of complications and a heavy financial cost from those complications.
The study involved more than 100,000 women with early-stage breast cancer. Researchers analyzed 10 years of medical claims data from two sets of women — one group of women ages 65 and under with private health insurance, and a second group of Medicare enrollees older than 65.
The findings: More than half of younger patients who had a mastectomy (breast removal) plus reconstruction experienced complications, such as infection. For women age 65 and older that received the procedure, the complication rate was nearly 70 percent.
Lumpectomy (where the cancerous tissue is removed), in comparison, had a complication rate ranging from about 30 to 45 percent among younger women.
“The available evidence indicates that fear of recurrence and misperceived benefit of mastectomy are the main factors causing more women to choose mastectomy,” says lead study author Benjamin Smith, MD, associate professor of radiation oncology at MD Anderson Cancer Center in Houston, Texas. “It is important to know if you, as a patient, can be appropriately managed with a lumpectomy and radiation. If so, then this treatment strategy may be a bit more inconvenient, but could very well be easier with fewer side effects,” Smith tells Yahoo Health.
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In the U.S., 140,000 women are diagnosed with early-stage breast cancer each year. In the early stages, “breast conservation therapy and mastectomies have similar results in terms of recurrence and survival,” explains Maggie DiNome, MD, director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.
“The main misconception is that a bigger surgery must mean a better outcome but that is just not the case. We are learning that less may be more for breast cancer patients,” says DiNome, who was not involved in the study.
Breast Cancer Treatment Options: Mastectomy Isn’t Always Best
Experts stress that everyone’s situation is different, and many factors go into a treatment decision. “Breast cancer treatment is becoming very individualized, and one size no longer fits all,” DiNome tells Yahoo Health.
“For a long time, we have known that stage-for-stage both lumpectomies and mastectomies have the same long term survival rate,” says Michele Carpenter, MD, Medical Director of the Breast Program at St. Joseph Hospital in Orange, California, who was not involved with the study.
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“Women of different ages, body shapes, and cancer stages have different requirements for treatment,” Carpenter tells Yahoo Health. “Some women just have too much cancer to have breast-conserving surgery. Some women are not candidates for chemotherapy to shrink tumors. Some women just don’t want reconstruction and all the time and effort it takes to reconstruct the breasts … My job really is at the beginning of the breast cancer care process to put this all in perspective and to educate the patients that mastectomy will not give them a longer life.”
Breast Reconstruction Carries Additional Risks
If a patient opts for a mastectomy, there are a number of additional choices that can impact the risks and benefits of the procedure. She may need to decide whether or not she would like breast reconstruction, for one.
And it’s the breast reconstruction, Smith points out, that brings the highest risk of complications. Opting for breast reconstruction more than doubles the rate of complications compared to mastectomy alone, from 25 percent to 56 percent, his research shows.
“Reconstruction typically entails multiple procedures spread over several months to more than a year,” Smith explains. “Each procedure carries risks and in many ways is more extensive surgery than a mastectomy. That is why cost and complications are so much higher with reconstruction compared to mastectomy alone.”
The average reconstruction patient undergoes five operations in her lifetime, Carpenter adds. “We as breast surgeons really try to educate the patient as to the best individual options for that particular patient. Sometimes no matter how hard I try, I cannot convince a young patient that breast saving operations are best,” she says.
The Cost of Breast Cancer Treatment Complications
Smith’s study, which was presented Dec. 10 at the San Antonio Breast Cancer Symposium, also analyzed the financial burden of complications.
Among the younger patients studied, a mastectomy plus reconstruction cost $10,000 in complications alone — a finding that Smith says surprised him. That’s compared to $1,400 to $3,600 for all of the other treatment options studied.
“The takeaway here is that no choice is perfect,” Carpenter concludes. “Mastectomy has different complication rates and more operations with reconstruction than lumpectomy, but lumpectomy does not keep you the way you always were. Choose the route that best suits your lifestyle and desires, and accept the facts that there are complications with any treatment option.”