Saturday, August 09, 2014

Psychology and Proplylactic Mastectomy

On Sunday, July 26th, 2014, the New York Times printed an opinion piece written by Peggy Orenstein titled "The Wrong Approach to Breast Cancer" in which Ms. Orenstein relays the results of a study published in 2009 in The Journal of Clinical Oncology, showing that the rates of mastectomy with contralateral proplylactic mastectomy (removal of the unaffected breast) jumped dramatically for those with very early stage breast cancer between 1998 and 2005 (Tuttle et al, 2009).  Most of these women did not have an increased genetic risk for the disease. Ms Orenstein points out that this occurred even though this surgical procedure has virtually no survival benefit, i.e. women who choose to have this, are apparently not living longer according to a recent study that appeared in the Journal of the National Cancer Institute.  In one study, young women chose to have this done even though the majority knew that this procedure would not prolong life.  They even often cited enhanced survival as the reason.  In addition, there are often complications and side effects associated with contralateral proplylactic mastectomy (CPM) and breast reconstruction such as infections, ruptured implants and lack of sensation in the reconstructed breast.

Why are women apparently so willing to give up a healthy breast even when they are informed that it will not increase their survival?  Ms. Orenstein cites several possible psychological  motivations such as the desire to flee from the diagnosis and put the whole thing behind them as quickly as possible. She mentions the power of "anticipated regret" - i.e. women want to feel that they have done everything they can to prevent a recurrence, especially when they have young children. "Patients will go to extremes to restore peace of mind, even undergoing surgery, that paradoxically, won't change the medical basis for their fear."  She aptly points out that self-sacrifice has long defined what it means to be a good mother.

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