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June 10, 2013 | Posted By Jane Jankowski, LMSW, MS

In a recent CNN article, it was reported that American women are requesting double mastectomies at vastly increased rates – up 150% among women with early stage breast cancer according to one 2007 study. With Angelina Jolie’s New York Times Op Ed piece hitting newsstands on May 14, 2013 the spotlight that has shown on breast cancer and its ancillary campaigns shines bright once again. There can be no doubt that breast cancer awareness, research, and treatment have become recognized beneficiaries of phenomenally successful fundraising campaigns. Yet, if we peel away the pink stickers, pins and flags, do we find empowerment of women or pressure to take action out of fear? To that end, what are the obligations of providers when faced with patients who demand mastectomies where there is no disease and no elevated risk?

In general, a patient’s demand for removing healthy body parts is considered ethically problematic. Is an orthopedic surgeon obligated to amputate a foot because it may someday be broken? This type of request would be declined on the grounds that the risks of surgery and ensuing debility are not worth the benefit of an unconfirmed and unlikely harm. Does our discomfort lessen if it is the amputation of a foot belonging to a diabetic patient out of fear it may someday loose circulation, become infected or gangrenous, and need amputation down the road anyway? The potential for complications related to diabetes may be genuine, but far from certain. Surveillance, lifestyle choices, and early intervention can mitigate the need for such a surgery and would be considered the standard of care for a concerned patient. For patients with BRCA mutations, prophylactic surgery and chemoprevention are added to the list of options. 

For women who have BRCA testing done – a genetic predisposition toward developing breast and other cancers due to an inherited genetic mutation. For women who are found to have such mutations, the risk is elevated. What is overlooked in the pink tidal wave of the women’s breast cancer movement is the increased risk of breast and other cancers (notably prostate cancer) in men who have the same BRCA mutations. The numeric risk for males is not as significant as that of the risk in females, but it is elevated from the norm. In my admittedly limited search, I have not seen data on men requesting prophylactic mastectomy based on positive BRCA test results. What was striking in this brief review was the presentation of the information. The percentage of risk is provided, but then stated in the number of patients who are unlikely to be affected thereby conveying a minimization of the likelihood of developing the disease

Celebrity health news like that of Ms. Jolie may spark increased discussion, and this is a good thing. We must be mindful, however, that the conversations remain individually focused and the pros and cons of each medical decision are carefully weighed. It is my hope that there will be further exploration and discussion of the culture of the breast cancer movement as a powerful entity and what that means for women, men, and providers. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
1 comments | Topics: Genetic Testing, Genetics, Oncology, Patient Autonomy

Comments

Breast Enhancement

Breast Enhancement wrote on 07/16/13 1:18 AM

I was just searching with the keyword 'Breast Cancer' and this article made me glued and I really liked the way it has been written.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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