When Dr. Todd Tuttle asks his female medical students at the University of Minnesota what they would do if they had breast cancer, he is always surprised by the large number who say they would choose to have both breasts removed, even if they didn't have to.
Now, he's found a similar pattern among a few female surgeons in Minnesota. In a study published this week, he found that women surgeons were much more likely than male surgeons to do double mastectomy procedures on breast cancer patients.
The findings are not conclusive -- only three of the 23 surgeons in the study were women. But they are enough to make Tuttle question whether there is a gender gap among surgeons about an aggressive and controversial surgical procedure that increasing numbers of patients are choosing.
In his study of 571 Minnesota breast cancer patients, the three women surgeons performed double mastectomies -- removal of both breasts -- on nearly half of their patients, compared with one in four for the male surgeons.
"It may be they recommend it more often," said Tuttle, a cancer surgeon and researcher at the University of Minnesota. "Or it may be that patients who want a double mastectomy seek women surgeons."
Researchers have known for some time that a small but growing number of women with breast cancer are choosing double mastectomies even when they have other less radical options, such as a single mastectomy or removal of the cancerous tissue from one breast, called a lumpectomy.
Survival Rates No Better Double mastectomies are controversial because, while removing a healthy breast virtually eliminates the chances of cancer occurring there, it does not improve breast cancer survival rates. Death from breast cancer usually results from the disease spreading out of the cancerous breast to other parts of the body, Tuttle said, not from a cancer that develops later in the second, healthy breast. In short, survival rates for women are the same regardless of what kind of surgery they have. But there is a lot of anxiety about breast cancer among women, Tuttle said. "Women fear it so much," he said. "Sometimes it leads to perhaps more aggressive treatment than is needed." A study Tuttle published this year found that, nationally, the vast majority of women with the early cancer, known as ductal carcinoma in situ (DCIS), still choose less aggressive options. But a growing number are opting for double mastectomies. The share who chose the more aggressive option rose from 2.1 percent to 5.2 percent between 1998 and 2005, a 148 percent increase, he found. Dr. Margit Bretzke, a breast cancer surgeon at the Piper Breast Center at Abbott Northwestern Hospital in Minneapolis said she believes the decision is driven by two things. Women don't want to live with the worry of breast cancer returning, or the extra lifelong vigilance of mammograms and biopsies. The other reason is cosmetic: Removal of both breasts results in more symmetrical re-constructed breasts, she said.
"I try to talk people into lumpectomies," she said. "But I have a hard time. I think it's patient-driven." Tuttle's study, published in the Annals of Surgical Oncology, also found that double mastectomy rates were much higher in Minnesota than the national average. Of the 571 patients in his study, 165, or just under a third, chose the most aggressive surgical option, he said. The study also found that among the Minnesota women, those with larger tumors and those under the age of 40 were the most likely to choose a double mastectomy.