The Angelina Effect

Voluntary MastectomyYou’ve probably caught wind of a recent movement for some women to opt for a voluntary mastectomy. Those two words seem scary, and you may wonder why an extreme surgery to remove breasts has become more commonplace. Isn’t that supposed to be a last resort?

Well, it actually makes a lot of sense, with the prevalence of breast cancer, the accessibility of genetic testing and the fear that comes along with being at high risk. Here is a bit more information surrounding the topic that you may not have considered.

Why A Voluntary Mastectomy?

Angelina Jolie brought preventative surgery into the spotlight in 2013 when she made the decision to undergo a double mastectomy and then another operation later to remove her ovaries and fallopian tubes. Jolie has a mutation of the BRCA1 gene, just like her mother, who passed away at age 56 after an eight-year battle with ovarian cancer.

By opting for surgery, her chances of developing breast cancer decreased from 87% to under 5% – a drop that made her decision completely defensible and rational. She followed up with reconstructive surgery on both breasts, and according to her New York Times piece, “There have been many advances in this [reconstructive] procedure in the last few years, and the results can be beautiful.”

The notoriety from Jolie’s story sparked a significant uptick in women getting mastectomies, which has already been on the rise since 2005. A study by the Agency for Healthcare Research and Quality (AHRQ), released in February, revealed that between 2005 and 2013, mastectomies increased 36%, and the number of double mastectomies tripled.

While lumpectomies followed by radiation had been more common in the past, radical surgeries seem to be the direction women are inclined, in order to lower their risk.

Potential Safety Concerns

One of the most popular of these surgeries is the ‘in-and-out mastectomy’ – meaning women go in for outpatient procedures and go home on the same day. Is this safe?

Lisa McGiffert, director of the Safe Patient Project at Consumers Union says there could be hazards to this type of procedure. “We know that more procedures in general are moving out of the hospital setting,” she said. “But the reality is we don’t know if outpatient clinics are safer than the hospital because we don’t have much information on quality in the outpatient setting.”

McGiffert did say, however, that some outpatient surgery clinics have “perfected” the procedure, so to speak, and are highly specialized, which can lead to improved quality.

Karuna Jaggar, executive director of the patient advocacy group Breast Cancer Action, noted she is “alarmed and concerned”. “As a patient watchdog group,” she said, “we would want to know that women are not facing undue pressure to go home before they are ready.”

Representative Rosa DeLauro, D-Conn., explained in an email statement that these surgeries are both physically and emotionally traumatizing for women; she plans to introduce a bill that requires insurance companies to keep patients in the hospital for 48 hours or longer after these operations.

Both Sides Have a Story

Dr. Otis Brawley, chief medical officer for the American Cancer Society, has said that some women are opting for the surgery out of fear, when they don’t actually need it. It is also a much more viable option with technology advancements.

“Women are choosing mastectomies because breast reconstructive surgery has improved and genetic tests are much more popular,” Dr. Brawley explained.

Positive post-surgery reactions like Jolie’s New York Times piece are also convincing women to have the operation: “The decision to have a mastectomy was not easy,” she explained. “But it is one I am very happy that I made … I can tell my children that they don’t need to fear they will lose me to breast cancer.”

Dr. Brawley points out, however, that despite the increases in surgery, the breast cancer rate is not changing significantly. Between 2008 through 2012, the rate stayed at 123.1 per 100,000 women. This is definitely something to consider for women weighing their options.

What Would You Do?

If you had a “faulty” BRCA1 gene, as Angelina Jolie described her condition, or considered yourself at higher risk for breast cancer, would you undergo an extreme surgery like a voluntary mastectomy?

Education is key. In her article, Ms. Jolie said, “I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.”

Know your options, and weigh the pros and cons. There are many differing opinions that make a case for both sides. Several factors play into the decision, primarily based on the specific case, such as a person’s age, family history, support system and other circumstances. Talk to doctors, but also trust your gut. Your boobs are part of your body, and you know them better than anyone.

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