Angelina Jolie’s revelation that she had a drastic double mastectomy to reduce her risk of breast cancer may inspire other women to have similar surgery, but many who don’t necessarily need the procedure are already opting for it, according to experts.
Todd Tuttle, chief of surgical oncology at the University of Minnesota hospital, found in a series of studies that women who develop cancer in one breast, women with early-stage breast cancer and women who were at a high risk of breast cancer tend to overestimate their risk of developing cancer in both breasts. Tuttle began researching the issue after noticing an uptick in the number of women opting for a double mastectomy in recent years.
The double mastectomy procedure, which Jolie chronicled in her New York Times op-ed on Tuesday, involves multiple operations, including removal of most of the breast tissue and reconstructive surgeries in many cases. Though it’s highly effective in reducing the risk of developing breast cancer for those, like Jolie, who test positive for mutated BRCA1 and BRCA2 genes, which correlate highly with breast cancer, many American women opt for the surgery even if they don’t have that risk, Tuttle said.
“I was at a meeting last week in Chicago and somebody came up to me and said this double mastectomy craze is becoming an epidemic because so many women are asking for it,” Tuttle told The Huffington Post. “There are a lot of women that I suspect who had a cousin who had breast cancer and they think they have high risk.”
There are a variety of reasons why more women may be asking for the surgery, including increased awareness of the genetic testing and recent improvements in breast reconstruction. Many women are happy with the results, but some -- both with the gene and without -- opt for surgery because they don’t have access to the counseling necessary to make an educated decision, Sofia Merajver, the scientific director of the Breast Oncology Program at the University of Michigan, told HuffPost.
“There are many people who opt for mastectomies even when the gene mutation is not discovered,” Merajver said.
In Europe and other regions where gene-testing technology is available, women are opting for preventive double mastectomies at much lower rates, Tuttle said.
“There’s a growing body of evidence that women in the United States that don’t have breast cancer markedly overestimate their risk of developing cancer,” Tuttle said. “There’s this very hyper-awareness of breast cancer, at least in the United States, where women have an unrealistic perceived risk of developing breast cancer.”
Otis Brawley, the chief medical officer of the American Cancer Society, wrote in an e-mail statement to HuffPost that while experts recommend patients “proceed cautiously” before electing to have the surgery, it may reduce the risk of developing cancer by as much as 97 percent.
“Women with BRCA mutations associated with a high risk of breast cancer, confirmed by testing, and with a strong family history of breast cancer, a previous breast cancer, and who show signs of certain pre-cancerous conditions are among those who could benefit from the surgery,” Brawley wrote.
Women with the gene mutation like Jolie face a 60 percent risk of developing breast cancer over their lifetime, according to data from the National Cancer Institute cited by NPR, compared with a 12 percent lifetime risk for women overall.
While there are other options besides surgery available for women who know they're at high risk of developing breast cancer, the double mastectomy is sometimes the "least stressful" option for many, especially when faced with a lifetime of tests, Ellen Matloff, the director of cancer genetic counseling at Yale University, told HuffPost.
"For some people this is just emotionally and physically the best option," Matloff said.
Tuttle said that when his patients ask for the surgery, he makes sure they know what’s involved in the procedure, including a month’s recovery time and risk of complications.
“It’s important that women take their time and think about that because it’s a big operation,” Tuttle said.