Ladies: Stop Cutting Off Healthy Breasts

bra_breast_cancerReally scary story in The Wall Street Journal this week about a dramatic increase in double mastectomies in this country — and not for women who need them.

Most women diagnosed with breast cancer only need a lumpectomy in the affected breast or, more rarely, a mastectomy. There is no evidence that removing the healthy breast reduces the risk of recurrence or increases survival.

Yet rates of double mastectomy among women diagnosed with breast cancer have skyrocketed in the past 13 years, from 2 percent in 1998 to 12 percent in 2011. And no, it’s not because women have been diagnosed with more severe breast cancer or some major study showed that slicing off healthy breasts keeps cancer at bay.

As one plastic surgeon quoted in the Journal article tells his patients: “Why don’t we simply remove your foot? It will have the same effect on survival.”

Don’t take my word for it; check out this study of 190,000 women with breast cancer that compared survival rates in those who had a double mastectomy vs those who underwent lumpectomy followed by radiation. Bottom line: No difference at all.

So what’s going on?

I think it comes down to vanity and ignorance. As several women in the Journal article explained: They wanted their breasts to match. And, thanks to a 1998 law that requires that insurers pay for reconstructive surgery after mastectomy — even if that mastectomy is not medically necessary — they don’t have to pay the additional $12,000 it costs to remove and reconstruct a healthy breast. Nor do they have to pay any costs for complications resulting from the surgeries (and these are major surgeries).

Wouldn’t that money be better spent on chemotherapy and radiation, which does increase survival?

And why would any woman want to subject her body  — already stressed by the cancer — to additional and unnecessary surgery and stress?

To be clear: I’m not saying that women should not be able to cut off healthy breasts if they want to. I’m saying they should have to pay for it themselves, just as I would have to pay for a breast lift because, like the double mastectomy, neither is medically necessary.

This mastectomy thing is emblematic of a major problem with health care in this country: We expect everything, regardless of the evidence, regardless of the cost. Millions of us demand — and get — CT scans, antibiotics, hysterectomies, knee surgeries, and caesarian sections (to name just a few) — that are medically unnecessary and carry the risk of greater harm than good.

Until we start considering the cost/benefit of treatments and procedures, we will continue to have the highest per capita healthcare costs in the industrialized world, costs that are slowly bankrupting the country.

 

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