Study: Mastectomy in Older Women Isn't Always the Best Choice

Mammograms showing a normal breast (left) and a cancerous breast (right).

The increasing use of magnetic resonance imaging (MRI) is leading to unnecessary, invasive surgery on older women who have breast cancer.

A Yale University study followed the use of breast MRI and surgical care of 72,461 female Medicare beneficiaries, age 67-94, who were diagnosed with breast cancer between 2000 and 2009.

The statistical rise in preoperative use of breast MRI during those years was startling: It jumped from 1 percent of patients in in 2000-2001 to 25 percent in 2008-2009.

Women who received an MRI, the researchers found, were more likely to subsequently undergo more aggressive surgical treatment. In women who underwent a mastectomy, 12.5% of those who had MRI received bilateral mastectomy, while only 4.1% of those who did not have MRI had bilateral mastectomy.

The study also found that women who had an MRI were likelier to have a prophylactic mastectomy, meaning that both breasts were removed although cancer was found in only one breast.

The researchers, whose findings were published in the journal Breast Cancer Research and Treatment, indicated that a decision to have a bilateral or prophylactic mastectomy should be carefully considered.

“These data are concerning because the long-term benefits associated with bilateral mastectomy for older women with breast cancer are unclear,” said the study’s lead author Dr. Cary Gross, associate professor of internal medicine at Yale School of Medicine and director of the Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale Cancer Center.

“Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit of the more aggressive option,” Gross added.

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