Double Mastectomies Are Rising, Along with the Costs
Life + Money

Double Mastectomies Are Rising, Along with the Costs

Angelina Jolie was at high risk for breast cancer. But many women choose mastectomy—just in case.
REUTERS/Lucy Nicholson

After Angelina Jolie announced yesterday in The New York Times that she underwent a double mastectomy to remove both breasts to dramatically lower her chances of contracting breast cancer, women who have had the same operation have shared their stories. 

Jolie’s mother died of the disease at age 56, and Jolie, 37, learned she had a gene mutation (called BRCA1 and BRCA2 genes, which account for 7 to 9 percent of all breast cancers) that put her at an 87 percent risk of developing a tumor, according to her doctors.

Approximately 100,000 women undergo mastectomies each year, according to Decision Researches, a Burlington, Massachusetts industry analysis group, and the popularity of the procedure has grown. Rates of double mastectomies more than doubled from 1.8 percent to 4.5 percent of women diagnosed with early-stage cancer between 1998 and 2003, according to a study in the Journal of Clinical Oncology. Dr. Kelly Hunt, a surgeon at Houston’s MD Anderson Cancer Center, tells CNN that she’s seen the rates of having both breasts removed increase dramatically in the past few years at the center.

But not everyone who chooses the procedure is as high risk for cancer as Angelina Jolie.

In a report last year by UK’s Independent Breast Screening Review, researchers estimated that there were around three cases of overtreatment for every death prevented from mammogram screening. Another study in Norway found that in screening 2,500 women 50 to 69 years of age, one death was prevented and 6 to 10 women were over-diagnosed.

The surgery is extremely invasive – and expensive. “The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film,” Jolie wrote in The New York Times. Costs for the full procedure – including breast reconstruction – can range from $15,000 to $50,000, depending on the location and the type of surgery. Insurance providers are not required to cover preventative mastectomies, though many do. The test alone for BRCA gene mutations can cost over $3,000. The test will be covered as preventative care under the Affordable Care Act if the patient can prove they have a family history of breast cancer.

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With BRCA gene mutations, a woman’s chances of developing a life-threatening cancer are much higher and the cancer tends to progress more rapidly. While Jolie chose to have a double mastectomy to decrease her chances of ever developing the disease, a growing number of the surgeries are performed after a tumor or cancerous tissue is found in one breast. Women are opting to have both breasts removed instead of the breast-saving lumpectomy surgery. There are a few reasons for the rise.

Advances in breast reconstruction have motivated more women to choose mastectomy, and increased mammogram screening and higher quality imaging have led to more diagnoses of early-stage, or in situ, cancers – currently about 60,000 every year, compared with some 7,000-8,000 in the 1980s. While catching a cancer at an earlier stage can save lives, some of the cancers detected are not ones that would have ever caused a problem for women in their lifetime.

That’s because it’s difficult for doctors to distinguish between faster and slower-growing cancers, which can lead to high rates of over-diagnosis and over-treatment. Many in situ cancers are benign, treatable, and will never develop into life-threatening cancer. A 2011 study from New York’s Memorial Sloan-Kettering Cancer Center found that most women having mastectomies for in situ cancers were not at high risk for relapse.

Many women choose mastectomies after an in situ or BRCA gene mutation diagnosis to lower their chances of developing life-threatening cancer and give them peace of mind. A recent study from the University of Pittsburgh Medical Center found that almost all the 206 women in the study who underwent a mastectomy of a healthy breast were happy with the decision, and listed fear of cancer as well as the reconstructive surgery options as factors. “Women have this exaggerated perceived risk of getting breast cancer,” Todd Tuttle, chief of surgical oncology at the University of Minnesota told NPR. “They see breast cancer everywhere.”

The costs of treating invasive breast cancer, of course, are much higher, and can top $100,000 a year. Some 230,000 women are diagnosed with invasive breast cancer every year, and about 40,000 women die from it. As for Jolie, she says her chances of developing breast cancer have now dropped to under 5 percent. “I can tell my children that they don’t need to fear they will lose me to breast cancer.”