Why Are More Women Having Mastectomies?

In 2013, actress Angelina Jolie elected to undergo a double mastectomy after testing positive for the BRCA1 gene mutation. This mutation greatly increases the risk for breast cancer. The star encouraged other women to get tested for BRCA1, and it appears many did.

After Jolie’s announcement, inquiries into genetic testing for the breast cancer-related gene skyrocketed. The long-lasting implications of Jolie’s decision have been dubbed the "Angelina effect." However, new evidence suggests that mastectomies were on the rise years before 2013.

The Agency for Healthcare Research and Quality (AHRQ) recently released a report showing that, although breast cancer rates remained constant, mastectomies increased 36 percent from 2005 to 2013 among US women. Double mastectomies tripled during the same period.

"This brief highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety," said AHRQ Director Rick Kronick, PhD, in a press release.

He continued, "More women are opting for mastectomies, particularly preventative double mastectomies, and more of those surgeries are being done as outpatient procedures."

The AHRQ report also showed an increase in double mastectomies among women who were cancer-free, although this number remained low.

Still, a significant number of women elected to undergo double mastectomies as a preventive measure in recent years. As of 2013, women who underwent double mastectomies were 10 years younger than women who had single mastectomies on average.

According to the AHRQ, the vast majority of breast cancers occur only in one breast. Surgical options include breast-conserving lumpectomies, single mastectomies and double mastectomies.

The AHRQ speculated that women who choose a double mastectomy over other breast-conserving options may be motivated by their doctor’s advice, a fear of cancer recurrence or a desire for cosmetic symmetry. The choice may also be motivated by a family history of breast cancer or a mutation in the BRCA1 or BRCA2 genes.

According to the National Cancer Institute, double mastectomies have been shown to reduce the risk for breast cancer by 95 percent in women who have BRCA1 or BRCA2 gene mutations. The surgeries can also reduce the risk by 90 percent in women with a strong family history of breast cancer.

As with any surgery, double mastectomies carry a risk for bleeding and infection. Women who undergo them may also develop psychological issues due to body image changes and loss of normal breast functions.

The full report can be found on the AHRQ website.

This research was supported in part by Minya Sheng of Truven Health Analytics and Anne Casto of Ohio State University. No conflicts of interest were disclosed.