妇女解释为什么他们尽管只有一个乳房患有癌症，但甚至在既不乳房也没有选择双重乳房切除术。
当癌症只有一个时，更多女性正在选择两种乳房。
The proportion of patients aged 45 and older who had contralateral prophylactic mastectomies rose from 3 percent in 2004 to 10 percent in 2012, according to a
Among women aged 20 to 44, it jumped from 10 percent to 33 percent.
Removing the unaffected breast does
In addition, the surgeryhas not been shownto help those women live longer.
So, why do they do it?
Read more: Removing the stigma of mastectomy scars »
As genetic testing becomes more common, we know more than ever about our health risks.
BRCA1 and BRCA2 genetic mutations are associated with increased risk of breast and other cancers. Testing helps women understand the risks of developing specific types of cancer, as well as whether they can pass the mutations on to their children.
It also helps in choosing treatment options or taking preventive measures.
One of those preventive measures is prophylactic mastectomy.
For women who carry the BRCA mutations or have a strong family history of breast cancer, the surgery may reduce the risk of developing breast cancer by
测试是一件事。解释结果是另一个。
A recentsurvey超过2000名新诊断的女性发现那t half who had a double mastectomy after genetic testing didn’t actually have mutations that increase the risk of additional cancers.
They had variants of uncertain significance (VUS), which are often harmless.
大约有一个遗传测试的女性从未与遗传辅导员讨论了结果。
在调查的四分之一和一半的乳腺癌外科医生之间表示，他们以同样的方式对待患有患有已知癌症相关突变的妇女。
Some women have the surgery before they ever get the results. Or before being tested at all.
Read more: New pill might make it easier to diagnose breast cancer »
At 45 years old, Charlotte Gajewski of Texas was diagnosed with stage 0 DCIS.
“它听起来很简单，”她用电子邮件写给了健康线。雷竞技app官网“但在两次肿块切除术后，他们继续在霰弹枪模式中找到更多癌症细胞的癌细胞。”
她测试了BRCA遗传突变的阴性，没有乳腺癌的家族史。
AnMRIof the unaffected breast revealed a flat tumor. It was non-threatening but would need to be monitored.
“So I elected to have a mastectomy and, ultimately, a bilateral mastectomy,” said Gajewski.
Her doctor explained the pros and cons of the surgery. Her only hesitation was whether or not to spare the nipple on the unaffected breast.
She chose radical mastectomy on both so she wouldn’t have to live with doubts and fears of recurrence.
She’s happy with her decision but says she has no feeling or sensation across her entire chest, which is both annoying and a constant reminder of what she went through.
“What sounded like a simple and ‘dream’ diagnosis turned into quite a fiasco for me. But life is good now and I am healthy and joyful every day,” said Gajewski.
Mari Gallion, 47, is an author living in Alaska.
Following the diagnosis oftriple-negative breast cancer, her doctor suggested breast-conserving surgery in the affected breast.
However, the first lumpectomy failed to get clear margins. The second, third, and fourth lumpectomies were also unsuccessful. It no longer made sense to keep trying to save the breast, even though she tested negative for BRCA mutations.
尽管只有一个乳房患有癌症，她将与她的外科医生一起决定双重乳房切除术。
The most important consideration was her health, she told Healthline.
“Early in the process, should mastectomy have become a reality, I was considering foregoing reconstruction when it was just one breast,” Gallion said. “My mom had a prosthetic, so I wasn’t afraid of that, but if two were being removed, I wanted them both done.”
加仑感觉幸运的是，她能够拥有乳房切除和直接的重建，而无需组织扩展器。
Not that it was easy.
She called the first four weeks after mastectomy “horrifying.”
“There were moments that I wished I hadn’t opted for reconstruction because of the pain and the time off work,” she said. “I had six surgeries all together, one of them three weeks after the mastectomy to remove the nipple, as there was a positive margin on my nipple. I understand it can be just as painful without the reconstruction. I was concerned about taking too many opioids, as I was literally watching the clock to see when I was allowed to take another pill. However, I am extremely happy with the result.”
“他们[我的乳房]有点疯狂地看着那个没有乳头，但我喜欢我可以穿我所有的旧衣服，”继续加仑。
She’s considering getting a 3-D tattoo in place of the missing nipple.
Read more: Clothing that makes life easier for people with cancer »
Comedian Caitlin Brodnick has never been diagnosed with breast cancer.
But she had a double mastectomy anyway.
她的一些推理是基于她的童年。她父亲的整个家庭都死于各种癌症，包括乳腺癌。
“Growing up, I was convinced I would get cancer. I was really afraid,” Brodnick told Healthline. “I was born just nine months after my aunt died of cancer. It was completely devastating and my whole family was anxious about health and cancer as a direct result.”
28岁时，她测试了BRCA突变。
The result was positive.
To Brodnick, it felt like a cancer diagnosis. In fact, she refers to it as a diagnosis.
“The official diagnosis and knowing I had the genetic mutation was scary. I thought it would be easier to have something you clearly knew how to fight. The idea that you’re more likely to get cancer is very vague. You have to continually test and see doctors for screening. You’re on the defense and it’s maddening. You don’t know if cancer is lurking around the corner,” she explained.
Brodnick Credits女演员Angelina Jolie与预防性乳房切除术谈话。jolie，携带BRCA1基因突变，去了following her preventive double mastectomy in 2013.
“医生是谨慎的，因为他们不希望患者在没有思考它的情况下将患者作为肠道情绪反应，”Brodnick说。
医生没有推动她的决定。
在与丈夫和其他家庭成员讨论后，她自己来到了自己。
She’d never had a major surgery before, so there was a lot of pre-op anxiety.
“我觉得手术后醒来的那一刻我感到完全救济，”她说。
She also had implants. The size didn’t work out, so the procedure had to be repeated. Other than that, there haven’t been any post-surgical complications.
“I had no idea I’d feel this great. Three years later, I’m strong and healthy.”
As satisfied as she is with her own decisions, she knows it’s not for everyone.
“A close friend had breast cancer at a young age and had a mastectomy. It was traumatic for her. Reconstructed breasts won’t ever be like real breasts,” she said.
Brodnick’s story is documented in the拧你癌症系列with Glamour magazine and her upcoming book, “危险的鲣鸟：用我的时间炸弹乳房分手.”
Read more: Breast cancer treatment options by stage »
Dr. Diane M. Radford is staff breast surgical oncologist at克利夫兰诊所克利夫兰诊所Hillcrest医院的乳房计划和医学主任。
When counseling patients with cancer in one breast, she follows the consensus statement from the American Society of Breast Surgeons and the明智地选择指导方针。
“我劝告妇女缺乏生存效益与CPM（对侧预防性乳房切除术）和增加的并发症风险，如出血和感染，”她在电子邮件中写给了健康线。雷竞技app官网
“In patients in high risk groups, such as BRCA gene carriers, the risk to the other breast is high enough to warrant CPM. My approach is evidence-based, and I review the pros and cons,” she said. “While CPM is the best risk reduction we can offer (about 95 percent risk reduction), the risk of cancer in the other breast is small in average risk women — 0.2 to 0.5 percent per year for those undergoing adjuvant therapies.”
No surgery is risk-free.
“出血的风险约为1％，感染风险也约为1％，”拉迪福德说。“所以，如果两种乳房都被删除，那么这种风险的增加达到2％和2％。有关是否定期对CPM进行顾虑的纵心节点活检进行辩论。我不经常对CPM进行纵心节点活检，因此没有风险lymphedemawith CPM.”
Medical decisions often involve more than statistics and probabilities.
还有一个生活质量问题。
Radford explained that if, after counseling, a woman at average risk for contralateral cancer wishes CPM, she would agree to do it.
“共识声明指出，CPM也可能适用于其他条件，如密集的乳房，召回疲劳，关注重建对称性和极端疾病相关的焦虑，”她说。“如果在我看来，患者对其他乳房的风险非常焦虑，那么为了生活质量，我就会执行康复。”