This is out of Mass General in the Plastic and Reconstructive Surgery Journal. As I have said, breast cancer (or the fear of it) seems to be everywhere. I have definitely seen the rise of prophylactic mastectomies, whether done on both sides (as in the case of someone with a strong family history or BRCA positive status), or on one side, when diagnosed with a cancer in the other breast.
So. The question this team was looking at was: which costs more? and do you find hidden breast cancers?
Is it more cost effective to do a major surgery and remove the breasts prophylactically? Or is more cost effective to screen the breasts yearly? And how many times do the prophylactic mastectomies find a hidden cancer?
Study:
- Retrospective prophylactic mastectomies from 2004-2011.
- 1100 records
- They compared prophylactic bilateral or unilateral mastectomies VS. yearly screening surveillance for 30 years. (assuming some of those with surveillance would need mastectomies as they would get breast cancer.)
- They estimated costs based on Medicare reimbursement rates.
Findings:
- 7% of the contralateral prophylactic breasts had cancer.
- Lobular carcinoma in situ was predictive on breast cancer in contralateral mastectomy (lobular are found to be bilateral more often)
- 11.4% of the bilateral prophylactic breasts had cancer. (!!)
- No predictors were found for bilateral cases
- BRCA status was NOT predictive.
- For costs, bilateral mastectomies were $2800 – $5700 LESS expensive than surveillance, depending on reconstructive method.
- Contralateral mastectomies were comparable to surveillance.
I found this abstract fascinating. Medicine is becoming more of a business to some in power, so analysis like this is important to allow us to be able to present choices to patients. When I see women with a strong family history of breast cancer, or a personal history of breast cancer, I think the option of taking off a breast preventatively is important. For some women, the constant worry –of the yearly mammogram, the waiting for biopsy results, the fear — incapacitates.
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