For Breast Cancer, Aggressive Treatment Does Not Mean Better Treatment

This article originally appeared in The Atlantic on Nov. 21, 2013.

By Mita Sanghavi Goel

Television reporter Amy Robach underwent a double mastectomy last week following an on-air screening mammogram last month as part of Good Morning America’s breast cancer awareness campaign.

Although initially her public mammogram was aimed to simply increase breast cancer screening awareness, her subsequent diagnosis has exposed a critical misunderstanding of breast cancer treatment and its benefits. Robach discussed her decision to elect double mastectomy to treat her cancer, telling her colleague Robin Roberts that she decided to be “very aggressive.”

With this seemingly innocuous statement she misleads the public to believe that more intense treatment equates to a higher chance for cure.

To be sure there are some circumstances when bilateral mastectomy leads to improved survival. For example, women with certain variations of the breast cancer gene BRCA and those with breast cancer arising in multiple locations of both breasts will benefit from bilateral mastectomy.

However, these circumstances are rare and may not apply to Robach.

As a physician and researcher who has studied breast cancer for 10 years, I have identified patterns in mastectomy overuse and developed educational materials for women about breast cancer. With the increasing speed with which information disseminates over television and social media, stories may influence treatment decisions more than facts.

Take for example recent research that shows young women are increasingly opting to have both breasts removed, even when they lack any cancer causing genes such as BRCA and have disease confined to only one breast. Rates of bilateral mastectomy have doubled in the past decade.

When asked to estimate their risk of developing disease in the opposite breast, most women overestimate their risk by double. Thus it seems many women undergoing this treatment are allowing themselves to have unnecessarily invasive treatment out of a misunderstanding of their future breast cancer risk. 

Many women argue that having both breasts removed provides psychological comfort. While this may be true, this benefit comes with a cost.

Mastectomy can lead to complications such as numbness and localized bleeding compared with its less invasive counterpart, breast conserving surgery. These complications can lead to additional surgeries and treatments over years.

Recent studies have shown that for the majority of women, having a bilateral mastectomy for cancer confined to one breast does not improve survival. Sadly, many women do not know, or internalize, this essential fact.

Public figures like Amy Robach influence health behaviors of the wider population. In May of this year, Angelina Jolie publicly announced her decision to have a preventive bilateral mastectomy as a result of testing positive for BRCA and watching her mother die of cancer.

Sometimes these events can be of significant benefit, such as when Katie Couric underwent a live screening for colon cancer, leading to increased rates of colonoscopies. Other times, their stories can be detrimental. 

In 1987, following her diagnosis with localized breast cancer, First Lady Nancy Reagan chose to forego breast conserving surgery, directly leading to an increase in copycat mastectomies.

It is unclear what influence Robach’s decision will have on women. While I applaud her courage in coming forward with her deeply personal experience, her celebrity status requires that she better explain the rationale for her bilateral mastectomy. 

Women select their breast cancer treatments while experiencing the nauseating fear that follows a breast cancer diagnosis. It is a time when women are exquisitely vulnerable to a powerful narrative. I should know. I was the recipient of a Stage 2B breast cancer diagnosis. Despite my years of experience as a physician and researcher, I was tempted to have a bilateral mastectomy with the false hope it would be better for me. Fortunately, my breast surgeon provided the most important piece of advice: take time to consider the options. Breast cancer is a psychological emergency but not a medical emergency. With the luxury of time, I realized that a bilateral mastectomy for me would be a high price to pay for the illusion of benefit.

To help women make more informed treatment decisions after their diagnosis, public figures need to carefully craft their stories. To not do so further perpetuates treatment myths such as “aggressive always equals better.”

-Mita Sanghavi Goel is an assistant professor of medicine at Northwestern University.