Are Prophylactic Mastectomies Better Than Annual Screenings in Terms of Cost?

This is out of Mass General in the Plastic and Reconstructive Surgery Journal.  As I have said, breast cancer (or the fear of it) seems to be everywhere.  I have definitely seen the rise of prophylactic mastectomies, whether done on both sides (as in the case of someone with a strong family history or BRCA positive status), or on one side, when diagnosed with a cancer in the other breast.

So.  The question this team was looking at was: which costs more? and do you find hidden breast cancers?

Is it more cost effective to do a major surgery and remove the breasts prophylactically? Or is more cost effective to screen the breasts yearly? And how many times do the prophylactic mastectomies find a hidden cancer?

Study:

• Retrospective prophylactic mastectomies from 2004-2011.
• 1100 records
• They compared prophylactic bilateral or unilateral mastectomies VS. yearly screening surveillance for 30 years. (assuming some of those with surveillance would need mastectomies as they would get breast cancer.)
• They estimated costs based on Medicare reimbursement rates.

Findings:

• 7% of the contralateral prophylactic breasts had cancer.
  • Lobular carcinoma in situ was predictive on breast cancer in contralateral mastectomy (lobular are found to be bilateral more often)
• 11.4% of the bilateral prophylactic breasts had cancer. (!!)
  • No predictors were found for bilateral cases
  • BRCA status was NOT predictive.
• For costs, bilateral mastectomies were $2800 – $5700 LESS expensive than surveillance, depending on reconstructive method.
• Contralateral mastectomies were comparable to surveillance.

I found this abstract fascinating.  Medicine is becoming more of a business to some in power, so analysis like this is important to allow us to be able to present choices to patients.  When I see women with a strong family history of breast cancer, or a personal history of breast cancer, I think the option of taking off a breast preventatively is important.  For some women, the constant worry –of the yearly mammogram, the waiting for biopsy results, the fear — incapacitates.