Preventative Mastectomy — Happy Acceptance of a Horrific Procedure

January 01, 1999  ·  Michael Fumento  ·  Cancer

To the media, it was wonderful news. A January 14 New England Journal of Medicine (NEJM) study showed there’s a highly successful treatment for preventing breast cancer. The downside, alas, is that it entails lopping off both breasts.

Who’s to say how many women will now elect this surgery, in part because of coverage that practically put it on par with eating right and getting plenty of exercise. ("Healthy Breast Removal is Backed," proclaimed the USA Today headline). And in part they will subject themselves to mutilation because for years they have been besieged by fearful false information about their true risk of breast cancer.

It’s not disputed that the treatment works. Men who want to avoid the most common cause of cancer death among non-smoking males could likewise have their still-health prostate glands ripped out. But few would find that appealing, and safe to say most women feel similarly about their mammary glands.

Actually, the preventative double mastectomy appears to be only about 90 percent effective, since it’s not possible to dig out all the mammary cells. So the only thing you’re absolutely assured of is no breasts.

"The fact remains that this is a study of 639 women who, because of the fear of breast cancer, underwent a disfiguring and potentially psychologically damaging operation," an accompanying NEJM editorial noted. Of these 639, it appears that 18 cancer deaths were prevented, two died despite the procedure, and 619 sacrificed their breasts who wouldn’t have gotten the disease anyway. Is this truly "reassuring news for the thousands of women who have had their breasts removed to prevent cancer," as the Washington Post put it?

Why so positive a slant on so horrific a procedure? The key word is "terror," terror carefully nurtured and spread by activist groups, the American Cancer Society, and the federal government.

Studies repeatedly show that women grossly overestimate their risk of breast cancer, especially younger women.

Why? For starters there’s that "one-in-nine" statistic we constantly hear. But it refers to the cumulative lifetime risk of breast cancer for a woman who lives past the age of 85, even though average life expectancy for white women is 79 and for black ones 74.

The American Cancer Society (ACS) concocted the figure, whereupon it was seized as a name for a powerful Long Island, New York activist group. "One-in-nine" quickly became a staple of any story on breast cancer and of government advice.

Yet even that hypothetical one woman of nine has only a 50 percent chance of being diagnosed with the disease until at least the age of 65. Then she has a 60 percent chance of survival, probably with breasts intact. A woman at 30 has about a 1 in 250 chance of breast cancer in the next 10 years; a forty-year-old has a 1 in 77 chance.

Repeated mentions of a "breast cancer epidemic" have also terrified women. In 1992, for example, the press referred to a breast cancer epidemic thirty-five times as often as to a prostate cancer epidemic, even though prostate cancer was causing almost as many deaths and its incidence was rising more sharply.

Further, we now know that the yearly increase in breast cancer had already ended in 1990 before the "epidemic" label caught on. As early as 1992, the NEJM remarked that breast cancer deaths remained "remarkably steady," but now they are dropping. Despite all this, Dr. Bob Arnot claims in a section heading in his October, 1998 best-seller The Breast Cancer Prevention Diet that "THIS IS AN EPIDEMIC, AND IT MAY ONLY GET WORSE." At least he avoids the one-in-nine figure. He uses one in eight!

Such is the fear frenzy that a just-released Harris Poll shows 40 percent of women believe they will contract breast cancer well over four times their actual risk.

Aside from the usual media sensationalism, the breast cancer fear frenzy has had many motives. They range from merely encouraging women to seek earlier testing, to book sales, to an awesomely successful effort to get more research money for the disease, to environmentalists using it impugn whichever chemical or chemicals they happen to be attacking at the time.

Whatever the motive, the result is most women have no idea that lung cancer kills considerably more American women than that of the breast, nor that heart disease kills more women than all types of cancer combined. This year, over 96 percent of American females will die of something besides breast cancer.

Even those genetically inclined to have a higher risk often overestimate it.

In any case there are valuable cancer-reduction alternatives to mammarial mutilation. Availing one’s self of earlier detection is one. Weight loss is another. Over half of American women are obese, a condition strongly associated with breast cancer. The drug tamoxifen in its one major trial cut the risk of developing breast cancer in half, and other preventative drugs are in advanced stages of human testing.

But whatever route a woman chooses, she should not become a martyr to someone else’s cause.