Preventative Measures Can Minimize Cancer Risk
- Comedian Wanda Sykes, 60, chose to undergo a preventative (also called prophylactic) mastectomy, which involves the removal of breast tissue to reduce the risk of breast cancer after she was diagnosed with the disease in 2011. Afterward, she said she wanted “zero chance” of having breast cancer.
- A prophylactic, or preventative, mastectomy is an operation where breast tissue is removed to reduce the risk of developing breast cancer. Women with genetic predispositions, like a mutation in the BRCA1 or BRCA2 gene, which increases their chances of breast and ovarian cancer, often consider this procedure.
- A new study published in the Journal of American College of Surgeons by researchers at UCLA Health found that Black women with cancer in one breast are less likely than white women to undergo a preventative mastectomy.
- Black women comprised roughly 71,000 of the nearly 597,000 women in the study. Overall, Black women were “35% less likely” to undergo a preventative mastectomy. At predominantly Black-serving hospitals, Black women were “17% less likely” to receive a preventative mastectomy.
“I had both breasts removed because now I have zero chance of having breast cancer,” Sykes once shared with the “Ellen DeGeneres Show,” according to CNN.
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New research published in the peer-reviewed Journal of American College of Surgeons finds that a sizable number of Black women aren’t following Syke’s path when it comes to preventative mastectomies (also called prophylactic mastectomy). “Black women with cancer in one breast are less likely than white women to undergo contralateral prophylactic mastectomies (CPM), a procedure to remove the unaffected breast,” authors of the study at the University of California, Los Angeles (UCLA) told UCLA Health.Within the study, UCLA researchers examined the disparity between Black women compared to white women receiving preventative mastectomies. Slightly more than 597,000 women participated in the study between 2004 and 2020, with nearly 71,000 being Black.
Among the group of women studied, overall, Black women were 35 percent less likely to undergo a preventative mastectomy. At predominantly Black-serving hospitals, Black women were 17 percent less likely to receive a preventative mastectomy.
“Our findings that Black-serving hospitals are less likely to perform CPM suggest these racial disparities are encoded structurally. We need to examine the systems-level factors affecting the care of Black women and address the deeper causes of structural racism to ultimately lead to equitable outcomes for all patients,” Amulya Vadlakonda, the study’s lead author at David Geffen School of Medicine, told UCLA Health.
The study draws added attention to racial disparities in healthcare and the need to Close the Gap regarding access to cancer care.
SurvivorNet strives to highlight racial and socioeconomic disparities impacting access to quality healthcare. We need to come together to discuss the critical blockers that prevent people in minority populations from accessing cancer care, engaging in basic preventive behaviors, and taking part in clinical trials. By working together and collaborating with partners like NYU, we at SurvivorNet believe we can move the needle. We hope to Close the Gap and help create a future free from healthcare inequality.
Expert Resources on Mastectomies
What to Consider When Weighing Preventive Mastectomy?
A prophylactic, or preventative, mastectomy is an operation where the breast tissue is removed to prevent cancer from developing in the future.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer for genetic mutation carriers, who are the ones at the highest risk; there’s unfortunately only one way to actually prevent breast cancer,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet.
“Women who are found to test positive for a genetic mutation really have two options,” Dr. Port explains. “One is what’s called high-risk surveillance, which means we check them every six months or so mammograms, MRIs with the hope that if God forbid, they develop breast cancer, we pick it up early. But that’s not prevention; it’s early detection.
“Early detection is a goal; it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
The benefits of a prophylactic or preventative surgery are:
- Significant reduction in cancer risk (from 80-90% to 1-2%)
- Nipples can often be spared
- Women can get reconstruction at the same time
- What Goes into Deciding to Get a Mastectomy?
When a woman decides to have a mastectomy, several factors go into that decision. Among things to consider is whether to have breast-conserving surgery such as a lumpectomy. These decisions should be made alongside your doctor by openly and candidly discussing risks vs. benefits.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Port said.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has,” Dr. Port continued.
Other factors that weigh into the decision to get a mastectomy are the size and features of the tumor and your family history. However, the gravity of your decision comes into full view, especially if you choose to get a mastectomy and remove both of your breasts.
WATCH: Regaining your sense of self after reconstruction.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
Dr. Port added that most women opt to have some reconstruction. The length of these surgeries can vary greatly. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area during reconstruction.
How to Choose the Right Surgeon?
Surgical procedures such as a double mastectomy can be an emotional part of a woman’s breast cancer journey. Choosing the right surgeon is extremely important for such a heavy part of the process.
SurvivorNet doctors say women should trust their gut when choosing a surgeon.
“You shouldn’t just ask surgeons how many operations they’ve performed because volume is not necessarily the best indicator of the right surgeon for you. On the other hand, you don’t want a surgeon who is inexperienced,” urologic oncologist Dr. Jay Shah said.
Above all, Dr. Shah says people who are faced with a choice of surgeons should go with someone they can trust.
Wanda Sykes’ Breast Cancer Journey
Wanda Sykes was diagnosed with stage zero breast cancer (or ductal carcinoma in situ – DCIS) in 2011. While going for a breast reduction, tests found that she had DCIS in her left breast, CNN reported.
DCIS has two important factors: It hasn’t spread to other parts of the body, and the risk of death is essentially zero.
The mother of two shared her diagnosis on “The Ellen DeGeneres Show” after having a double mastectomy, which is the removal of both of her breasts. She also underwent reconstruction after the mastectomy.
WATCH: What happens during a double mastectomy?
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Port said.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has,” Dr. Port continued.
Afterward, some women decide to have their breasts reconstructed and have implants put in, while others don’t have reconstruction at all.
It should be noted that a double mastectomy may not be the recommended treatment for others with DCIS. Choosing the right treatment is a very personal decision, and you should discuss your options with your doctor.
Although Sykes eventually went public with her breast cancer battle, it took her several months before she started telling others about it.
Sykes’ decision to wait to share such a personal health experience is completely normal, says Dr. Lori Plutchik.
Dr. Plutchik told SurvivorNet that some people feel comfortable sharing the information widely with family, friends, and others.
“Other people are much more private about it,” she says, “And there is no one right way to handle this diagnosis.
“People should do what feels right to them,” she said.
In the years following her breast cancer diagnosis, Sykes has been an advocate for breast cancer awareness by doing PSAs promoting early detection through mammograms and self-exams. During her PSA, she announced she’s still “cancer-free.”
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
- What should I know about implants? Should I opt for preventative surgery?
- What will recovery look like after the procedure?
- What are the benefits of a watch & wait approach vs. preventative surgery?
- What kind of surveillance is required after the surgery?
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