More women removing healthy breasts despite lack of benefit

In 2013 Angelina Jolie made headlines by revealing that she had undergone a prophylactic double mastectomy, removing both breasts to reduce her risk of cancer. For people with BRCA1/2 mutations, such as Jolie, this can be a wise decision. But researchers from Brigham and Women’s Hospital, Boston, have found that a growing number of women choose to remove both breasts, including the healthy one, even when only one breast is affected by cancer.

The practice is known as contralateral prophylactic mastectomy (CPM), and their study found that there is no benefit from carrying out this procedure unless women have at least one high-risk factor. The study from Brigham published in March 2016 was the result of a long-term study of almost half a million women with stage 1-3 breast cancer. Only one third of women who underwent the double mastectomy from 1998-2012 had a high-risk factor. CPM accounted for the smallest percentage of treatment options overall but the practice more than tripled in the years from 2002 (3.9%) to 2012 (12.7%). Women who chose to go the CPM route tended to be Caucasian. Angelina Jolie’s decision to undergo CPM was part of this overall trend but the publicity she received for this decision has acted as a catalyst and increased the numbers of women electively choosing to opt for CPM further.

The phenomena is now named the Jolie Effect. A study published in the journal Cancer compared awareness rates of CPM in Austria before Jolie revealed her decision in May 2013 and afterwards. The polls taken afterwards indicated that 20% of the 1000 women questioned cited Jolie influencing how they thought about breast cancer. There was a significant increase in public awareness of breast reconstruction options after Jolie’s announcement with a clear preference for autologous reconstruction over artificial implants. The study found that the media’s coverage of celebrity health issues can become a statistically significant tipping point to increase awareness of health related topics.

But, As the Brigham study showed the decision to remove healthy breasts does not necessarily carry a benefit beyond avoiding breast asymmetry. Jolie’s influence has led to an increase in demand for genetic testing for BRCA genes. However researchers have warned that they do not have the statistical evidence yet to say definitively whether all of the mutations caused by the BRCA1 and BRCA2 genes result in cancerous growths. The results can confuse rather than enlighten, and the decision whether or not CPM is the right decision for everyone with BRCA1 and 2 is not cut and dry without further data that only time can provide.