Surgical choices are difficult, but being informed helps make them easier.
Bonnie Annis is a breast cancer survivor, diagnosed in 2014 with stage 2b invasive ductal carcinoma with metastasis to the lymph nodes. She is an avid photographer, freelance writer/blogger, wife, mother and grandmother.
At the time of my diagnosis with breast cancer, I was presented with various surgical options. My breast surgeon spent several hours going over each option in great detail. She wanted me to understand every aspect of the procedure. She knew I’d want to make an informed decision. As we sat in her office, she allowed me to ask questions. As she answered each question, she also drew diagrams. She wanted me to fully understand what was going to be involved in my surgery. The first option presented was a breast conserving lumpectomy. Before this procedure, markers would be inserted into the tumor and blue dye would be injected into my breast. The dye would travel into the sentinel node illuminating areas for possible removal. Biopsies would be taken and, depending on the outcome, those nodes would be removed. After healing, I’d begin treatment which would include chemotherapy, radiation, and years of anti-hormone therapy. I’d need to have mammograms every three months, and if anything suspicious was discovered, I’d need more surgery.
The second option was to have a radical mastectomy. All of my breast and surrounding tissue would be removed. I’d also need to have the sentinel nodes checked for possible spread of cancer. This surgery was more involved and would necessitate a longer period of healing, but would give a greater chance at excising all existing cancer from my body. After my wounds had healed, I’d begin treatment, which would possibly include chemotherapy, radiation and years of anti-hormone therapy.
I considered each choice presented. It wasn’t something I took lightly. I knew the choice I made would be something I’d live with for the rest of my life. I did not choose the lumpectomy. Going through surgery to remove a cancerous mass would be challenging enough, but to have it done repeatedly with a final outcome of mastectomy seemed too much to bear. I didn’t want to have my tissue dissected bit by bit over extended periods of time. My mindset was more “once and done.” Although I knew there were no guarantees, I opted to go to the route of mastectomy.
The surgeon instructed me to take home all the information presented and spend some time processing. She told me not to rush, but to let her office know my decision whenever I’d made it. That evening, as I looked over the diagrams she made and thought about my options, I knew what I had to do. I was going to choose mastectomy and not only that, I was also going to ask the breast surgeon to remove my healthy breast, too. It was important to me to eliminate any possible chance of recurrence.
I took some time before calling my doctor. I wanted to research mastectomies and understand both the surgery and aftermath. As I began my quest for knowledge, I discovered there are many types of mastectomies. There are partial, nipple sparing, modified radical, radical, prophylactic and contralateral prophylactic mastectomies. Since I’d chosen not to have reconstruction after surgery, I knew the nipple sparing mastectomy was out. I chose contralateral prophylactic mastectomy, also known as CPM.
A contralateral prophylactic mastectomy (CPM) is a risk-reducing mastectomy performed in the clinical setting for the patient diagnosed with an invasive or a noninvasive breast cancer. According to an article
by Steven J. Katz, M.D., M.P.H. and Monica Morrow, M.D., published in JAMA
in August 2013, “The use of prophylactic mastectomy in the U.S. among patients with invasive breast cancer in only one breast has increased dramatically in the past two decades. Although removal of the noncancerous breast has been shown to reduce the risk for developing cancer in that breast, there is conflicting evidence on whether or not the practice actually reduces breast cancer mortality or overall death.”
The article also states, “…that the sense of urgency for cancer treatment and concern that any delay could worsen prognosis, coupled with a general belief that ‘bigger is better’ when it comes to surgery, leaves patients at risk for unnecessary harm and overtreatment.”
In the article, the authors refer to a study conducted on a large group of women who were diagnosed with breast cancer in only one breast. It was found that for the women at average risk of developing a second primary breast cancer, the removal of the unaffected breast for preventive reasons only was not beneficial in terms of improving survival. For this reason, current recommendations point toward removal of the unaffected breast only in cases where there is a high risk of developing a second primary breast cancer. Despite evidence to suggest removal of both breasts increases risk for complications, many patients continue to choose more aggressive operations. Researchers argue that patients don’t quite grasp the adverse effects of more aggressive surgical treatments and often overestimate their risk of developing a second primary cancer and the benefits of removing the unaffected breast. In order to combat these errors in understanding, the article maintains that surgeons need to ensure patients fully understand both benefits and risks of more aggressive surgical treatment, and patients should take more time to weigh these benefits and risks before making rash decisions based on emotional responses.
When I made the decision to have a contralateral prophylactic mastectomy, I knew it was the right decision for me. Each woman diagnosed with breast cancer must make the best possible choice, and only she can determine what that choice will be. Understanding all options clearly is the most important place to begin, and having a trustworthy physician will help make those life altering decisions easier. Choosing to amputate a body part is difficult, but saving a life is the most important of all. When it comes down to it, we do what we have to do whether we really want to or not. We do what we need to do to live. The alternative is death and most of us want to prolong the inevitable as long as possible.