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More and more men with breast cancer are opting to get the unaffected breast removed, despite evidence that the surgery doesn’t help women with the disease live longer, experts reported Wednesday.
White, younger men who have health insurance are the most likely to have the procedure done, the report by American Cancer Society and Dana Farber Cancer Institute researchers finds.
In 2004, just 3 percent of men diagnosed with breast cancer opted to have the unaffected breast removed – a procedure called contralateral prophylactic mastectomy. By 2011, this had risen to 5.6 percent of men, the team reports in the Journal of the American Medical Association’s JAMA Surgery.
Dan Miller is one of them. Miller was diagnosed with breast cancer earlier this year and will get both breasts removed later this month.
“Because my breast cancer is ER- and PR-positive and HER2 positive, chemotherapy comes first for me, followed by a mastectomy (likely a double, because why not) and then potentially radiation (although there is little to no data that says do it or don't do it for men in this situation),” said Miller, who is from Sammammish, Washington.
"I, like anyone else with this disease, am highly motivated to do whatever it takes for the best possible outcome."
The jargon means his cancer is affected by various hormones, including estrogen.
He has the BRCA-2 cancer gene, so has chosen to get surgery on both sides although the tumor is only in his left breast.
“As a 41-year-old man with two young daughters and a wife, I, like anyone else with this disease, am highly motivated to do whatever it takes for the best possible outcome,” he writes in a blog post for the Male Breast Cancer Coalition.
The researchers are concerned, because such surgery is pricey, puts people in the hospital and might not help them.
"The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care," the American Cancer Society’s Ahmedin Jemal said in a statement.
"Health care providers should be aware that the increase we've seen in removal of the unaffected breast is not limited to women, and doctors should carefully discuss with their male patients the benefits, harms, and costs of this surgery to help patients make informed decisions about their treatments."
Only 1 percent of all breast cancer cases in the U.S. are in men. Male breast cancer patients often don't survive as long as women, largely because they don't even realize they can get it and are slow to recognize the warning signs, researchers say.
The researchers found 6,332 men who had surgery for breast cancer between 2004 and 2011.
“During the period from 2004 to 2011, of 6,332 men undergoing surgery, 1,254 (19.8 percent) underwent breast-conserving surgery, 4,800 (75.8 percent) had a mastectomy, and 278 (4.4 percent) underwent a bilateral mastectomy,” they wrote in their report.
“Between 2004-2005 and 2010-2011, the rates of contralateral prophylactic mastectomy among men who underwent surgery increased by 86.7 percent, from 3 percent to 5.6 percent.”
What they don’t know yet is whether the men had genetic testing that showed they were high risk, whether they had a family history of cancer or whether they were worried the cancer would come back in the unaffected breast.
“I think this is probably a reaction of emotion,” said Dr. Larissa Korde, a breast cancer researcher at Fred Hutchinson Cancer Research Center in Seattle.
Rates of women who are opting for preventive mastectomies have increased by an estimated 50 percent in recent years, experts say.
“I think this is probably a reaction of emotion."
That’s even though it doesn’t help survival for most women. Researchers reported in 2014 that 70 percent of women who had a healthy breast removed after getting cancer diagnosed in the other one had a very low risk of getting a tumor in that healthy breast.
One high-profile exception was actress Angelina Jolie, who says she has a series of genetic mutations that put her at extremely high risk of both breast and ovarian cancer. Doctors said her decision was appropriate.
“What people are experiencing when they go through cancer is not necessarily just ‘Am I going to die when I get another cancer?’ It’s ‘I don’t want to go through this again’,” said Korde, who was not involved in the research.
It’s not clear if men might benefit more from having a bilateral mastectomy, or less.
“We need more data,” said Korde. “My gut says there is not a higher risk for a second cancer.”