Is A Preventative Double Mastectomy For Me
A woman newly diagnosed with breast cancer will often say, when discussing her surgical options, Why not just take them both off? These patients often express a desire to never have to worry about my breasts again, particularly those women who have had difficulty with screening procedures in the past or have a history of multiple breast biopsies. Women in whom the primary cancer was initially missed often lose faith in mammography and other screening methods and may feel that the only way to be sure this will not happen to them in the future is to remove both breasts.
Double mastectomies have been featured more in the mainstream media, increasing awareness of this option. Furthermore, the option of immediate reconstruction serves to make this route more appealing than in the past. But what is the real risk of developing a new cancer in the other breast? Do double mastectomies really save lives or improve quality of life? The answer is different for every woman. This article seeks to address these issues and assist individuals in making the most informed decision.
Can Breast Cancer Recur After A Mastectomy
A mastectomy is a surgical procedure that removes an entire breast. This procedure may be used as a treatment for breast cancer or a preventative measure for individuals at high risk of developing breast cancer. If your physician has recommended a mastectomy as part of your treatment plan, you may be wondering if this procedure will prevent breast cancer recurrence. Although a mastectomy removes all of the breast tissue, there is still a chance that breast cancer can return.
What Is The Breast Cancer Recurrence Rate After A Total Mastectomy
While being told you are in remission following your total mastectomy is undoubtedly a reason to celebrate, chances are theres still one thing on your mind recurrence. Its frustrating and scary to think that even if youve had your entire breast removed, your cancer might still come back. So, how likely is it that your breast cancer will recur? The truth is that its impossible to know, but experts believe there are some factors that put a woman at a higher risk of breast cancer recurrence. One indicator is lymph node involvement. The more lymph nodes that had cancer at the time of the mastectomy, the greater the chance of recurrence. Experts also believe that those who were initially diagnosed before the age of 35, those who had inflammatory breast cancer or those whose breast cancer did not respond to hormone therapy may also be at a higher risk for recurrence. However, having one or more of these risk factors isnt a reason to panic. Just like there was no way to know that you would develop breast cancer in the first place, theres also no way to tell if you will have a recurrence, and many survivors never experience a relapse.
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Fears Of Cancer Recurrence Affecting Decisions
According to recent studies, women with breast cancer have been increasingly choosing to have this aggressive surgery because they are worried about recurrence. About three-quarters of patients reported being very worried about their cancer recurring.
But a diagnosis of cancer in one breast does not increase the likelihood of cancer recurring in the other breast for most women, according to the researchers.
Lead study author Sarah Hawley, Ph.D., associate professor of internal medicine at the University of Michigan Medical School, said in a press statement that women appear to be using worry over cancer recurrence to choose contralateral prophylactic mastectomy, This does not make sense, because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast, said Hawley.
The study also found that women with higher education levels and women who had undergone an MRI test before surgery were more likely to choose double mastectomy. Concern about recurrence was one of the biggest factors driving the decision to have this surgery.
What Are The Breast Cancer Recurrence Statistics
Most of the time, local recurrences of breast cancer happen within the first five years after being diagnosed. After a mastectomy, when the lymph nodes have not been affected by cancer, the chance of local recurrence within the five-year period is only about six percent. If there was cancer in the lymph nodes at the time of the mastectomy, the risk increases to approximately 23% without radiation therapy after the surgery. Radiation can help decrease the risk to about 17%. It has also been shown that women that have tumors of 5cm have a 25% higher risk of having a recurrence after mastectomy.
For over 20 years, our team at Causenta has been using the latest, cutting-edge, non-toxic therapies to work with patients that have been diagnosed with breast cancer or breast cancer recurrence after mastectomy. Our oncologists work closely with naturopaths and physical therapists to provide an individualized cancer treatment plan for each patient. Patients from all over the world are finding relief as they work with our experienced team at Causenta. Is Causenta is right for you? Contact us today to schedule a free 30-minute consultation.
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Symptoms Elsewhere In The Body
Sometimes breast cancer cells can spread from the breast to other parts of the body. This is known as secondary breast cancer.
Some symptoms to be aware of include:
- unexpected weight loss and a loss of appetite
- severe or ongoing headaches
Find out more about the symptoms of secondary breast cancer.
How Do Surgeons Use Implants To Reconstruct A Woman’s Breast
Implants are inserted underneath the skin or chest muscle following the mastectomy.
Implants are usually placed as part of a two-stage procedure.
- In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle . The expander is slowly filled with saline during periodic visits to the doctor after surgery.
- In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomythat is, a tissue expander is not used to prepare for the implant .
Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or sling to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.
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Can I Lower My Risk Of Getting A Second Cancer
There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers that are more likely after breast cancer.
To help maintain good health, breast cancer survivors should also follow the ACS Guidelines on Diet and Physical Activity for Cancer Prevention:
- Get to and stay at a healthy weight.
- Keep physically active and limit the time you spend sitting or lying down.
- Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods.
- It’s best not to drink alcohol. Women who drink should have no more than 1 drink per day.
These steps may also lower the risk of some other health problems.
See Second Cancers in Adults for more information about causes of second cancers.
What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
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Possible Side Effects Of Mastectomy
Bleeding and infection at the surgery site are possible with all operations. The side effects of mastectomy can depend on the type of mastectomy you have . Side effects can include:
- Pain or tenderness at the surgery site
- Swelling at the surgery site
- Buildup of blood in the wound
- Buildup of clear fluid in the wound
- Limited arm or shoulder movement
- Numbness in the chest or upper arm
- Neuropathic pain in the chest wall, armpit, and/or arm that doesnt go away over time. It is also called post-mastectomy pain syndrome or PMPS.
- If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
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What Causes Breast Cancer Recurrence
The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.
Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.
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Treatment Of Local Recurrence After Previous Mastectomy
Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.
Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.
How Is Recurrent Breast Cancer Diagnosed
Many women who have had breast cancer in the past pay close attention to their bodies and are very aware of even the smallest changes. But many physical changes or health problems have nothing to do with the cancer they had before. Signs of breast cancer recurrence may include a lump in the breast, scar tissue or the chest area, as well as inflamed skin. Some women will notice these changes themselves, or a doctor might find them during an examination, for example during a check-up.
If you suspect that your breast cancer has come back, your doctor is the first person to go to. You might be referred to a hospital, tumor center or certified breast center for additional tests. If you are no longer at the same practice or center where you were treated for breast cancer the first time, it is important to bring along as much information as possible about your previous treatment. You can also consent to doctors sharing the relevant information about you with each other.
After a detailed talk about your medical history, you will have a physical examination, mostly to inspect the breast or the surgical scar. If breast cancer has come back, your doctor will also check whether the tumor has spread to the other breast or any other parts of your body. Any abnormalities in the body will be examined more closely. The breast cancer will then be classified using certain criteria, in the same way that it was when you first had this disease.
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Myths About Breast Cancer Survivorship
MYTH: Eating soy products after having hormone receptor positive breast cancer increases my chance of a recurrence.
FACT: Research on soy has been conflicting over the years. It has the capacity to mimic as well as block certain estrogens. Overall, natural dietary soy in the form of soy milk, soy bean sprouts, tofu or tempeh appears to be safe and may provide significant health benefits when it replaces animal sources of milk and protein. However, soy in concentrated forms such as pills, powders and supplements has the strongest potential for estrogenic activity and probably should be avoided by anyone who has been diagnosed with hormonal receptive breast cancer.
MYTH: If I tested positive for the BRCA1 or BRCA2 gene mutation, I must have a bilateral mastectomy.
FACT: Women with a BRCA mutation do have an increased risk of having a second breast cancer and many do choose to have bilateral mastectomies as a preventive measure. However having a BRCA mutation does NOT mean that you have to get a mastectomy. Women with a BRCA mutation are still good candidates for breast-conserving therapy and many choose this for their breast cancer treatment. Women with a BRCA mutation and any residual breast tissue need to be followed closely and are advised to have enhanced breast cancer screenings.
MYTH: My deodorant contributed to my getting breast cancer.
FACT: This is completely false! No evidence has ever been shown to prove this.
MYTH: Eventually, I will be able to stop my mammograms.
What To Expect From Recovery
You can expect temporary soreness in your chest, underarm and shoulder, as well as possible numbness across your chest that may be permanent.
The surgical drains that were inserted inside your breast area during surgery typically stay in for about one week to 10 days.
While recovering from surgery, most people have some pain. Recovery times vary depending on the specifics of your double mastectomy.
- After a mastectomy without breast reconstruction, it can take three to four weeks to feel mostly normal.
- If you also have breast reconstruction, recovery can take six to eight weeks.
- For some procedures, it can take months before you can return to being fully active.
You’ll likely receive a written list of instructions about post-surgical care that includes:
- How to care for the surgery site and dressings
- How to recognize signs of infection
- Tips for bathing and showering after surgery
- When you can use your arm again
- Arm exercises to prevent stiffness
- Restrictions on activity
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Factoring In Diet And Exercise
The idea of using other targeted therapies along with AIs to prevent breast cancer recurrences is catching on, thanks to positive results in patients with advanced disease. In one trial, combining the CDK4/6 inhibitor Ibrance with the AI Femara reduced the risk of disease progression by 44 percent and improved the time without progression by more than one year, compared with Femara alone. The most common side effects were low white blood cell counts, infections, nausea and fatigue. However, whether CDK 4/6 inhibitors can work in early-stage breast cancer and lower recurrence risk further than hormonal therapy alone remains to be seen, with several large trials in progress.
When Vicki Singer Wolfs breast cancer returned in 2016 21 years after her initial diagnosis and 10 years after one recurrence she opted for a double mastectomy, followed by chemotherapy. Now in her second year of treatment with an AI, she is focusing on adopting healthy habits, such as eating a mostly plant- and fish-based diet and exercising regularly. She hopes that these lifestyle changes will both prevent her cancer from coming back and help her deal with the medicines side effects, which include occasional joint pain, fatigue and insomnia. I have three wonderful grandchildren that Im around a lot. I want to have the energy to play with them, says Singer Wolf, 60.
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What Factors Contribute To The Risk Of Breast Cancer Recurrence
Whilst it is never completely certain that breast cancer has been cured, there are many treatments available that reduce the risk of recurrence. There are a number of risk factors that can contribute to a breast cancer recurrence.
Your age at first diagnosis Younger women, particularly those who had their first diagnosis under the age of 35, have a greater risk of recurrence. This is because those diagnosed at a young age are more likely to have aggressive features in their breast cancer. Additionally women diagnosed with breast cancer before menopause have a greater risk of recurrence.
Tumour size Women who have a larger breast tumour have a greater risk of recurrence.
Lifestyle factors Lifestyle factors can influence the risk of recurrence. Excess weight is associated with a higher risk of postmenopausal breast cancer and is also associated with a higher risk of breast cancer recurrence and death. Smoking has also been shown to increase the risk of recurrence. Women who exercise regularly appear to have a lower rate of breast cancer recurrence.
Lymph node involvement If cancer is found in lymph nodes at the time of the original breast cancer diagnosis, there is an increased risk of breast cancer recurrence. This is the strongest prognostic factor, and the more nodes involved, the higher the risk of recurrence.
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Talking To Family And Friends About Your Illness
Women who have breast cancer are often concerned about how the disease will affect their relationship with their partner and if they are mothers their children. The stress of treatment often makes sexual needs a lower priority for a while. It can affect your daily routine and require a lot of decisions and planning. All this can give rise to conflicts. It’s important to keep talking to your partner. If you have reached your limits you can get psychological counseling or support, either individually, or as a couple.
Whether children are still very young or already grown up, many mothers find it difficult to talk to their children or grandchildren about their disease. It might stir up memories of the first time they were diagnosed and the same fears may resurface, along with new worries as well. But even if you would rather protect your children from this situation, children do sense when something is wrong. So it is a good idea to speak openly with them about the cancer coming back and about the fact that there may be more treatment to come, and that you may once again need to rest more often.