Wanda Sykes has double mastectomy: growing trend for breast cancer prevention?

By Deborah Kotz, Globe Staff

Word is spreading today that comedian Wanda Sykes had a double mastectomy to treat an early stage of breast cancer. Sykes revealed on the Ellen show that will air Monday that the cancer was accidentally found when she went in for a breast reduction last February.

It was actually a ductal carcinoma in situ -- a noninvasive capsule of suspicious cells or “zero stage” cancer -- that has the possibility of transforming into an invasive, life-threatening tumor. While DCIS may never spread beyond its tiny capsule, it warrants removal since oncologists can’t predict the trajectory that DCIS will take.

But Sykes took the extreme approach: having a double mastectomy to remove a healthy breast and one that had the DCIS.

“I had the choice of, you can go back every three months and get it checked. Have a mammogram, MRI every three months just to see what it’s doing,” she told talk show host Ellen Degeneres. She also worried about her family history of breast cancer, which she previously didn’t know about. “Now I have zero chance of having breast cancer.”

The more-is-better approach to preventing breast cancer appears to be a growing trend as more women opt for genetic screening and prophylactic mastectomies if they’re found to carry a mutation in one of the BRCA genes.

Certainly gene carriers who are told that they could have a 60 percent lifetime risk of developing breast cancer -- often a more aggressive kind that occurs at younger ages -- have a decision to make that’s weighted strongly in favor of breast removal for prevention.

But they need to realize that it’s not 100 percent effective as Sykes was led to believe. Studies suggest prophylactic mastectomy reduces breast cancer risk by 90 percent in women of moderate to high risk, which still leaves that small possibility of breast cancer.

And what about women, perhaps like Sykes, who have suspicious findings that put them at higher risk of breast cancer, but perhaps not very high risk? (Sykes didn’t say whether she was a gene carrier.) Would they perhaps make different decisions if doctors took the time to explain their actual risks and discuss their fears?

Surveys indicate that women fear breast cancer more than heart disease despite the fact that heart disease kills more women every year. And a British study last year found that patients requesting prophylactic mastectomies often overestimate their breast cancer risk. Some assume it’s a forgone conclusion.

The small study, involving 27 breast cancer patients who asked to have their other healthy breast removed, found that those who were given counseling to help them understand their actual risk often opted against the prophylactic mastectomy.

I also wonder how much time doctors spend talking to patients about the pain of breast reconstruction, which often involves multiple surgeries and the loss of pleasurable sensation during sex.

As the American Cancer Society’s website states: “Breast reconstruction restores the shape of the breasts but cannot restore your normal breast sensation. With time, the skin on the reconstructed breast can become more sensitive, but it will not give you the same kind of pleasure as before a mastectomy.”

Back in the 1990s, I was writing articles on research showing that lumpectomies provided breast cancer patients with similar survival rates as mastectomies and on the push by leaders in the cancer community to educate women on the less-is-more approach to treatment. Now, though, I wonder if the pendulum is swinging back the other way -- avoid breast cancer at any cost.

A cousin of mine last month opted to have a prophylactic mastectomy on both breasts after having a few abnormal findings on her screening mammograms. “I couldn’t stand going in for biopsies every six months,” she told me while recuperating from the procedure. After seeing our grandmother and great-aunts die from breast cancer when we were young children, I could understand her fears.

But my cousin tested negative for the breast cancer gene mutations, and her doctor told her that her lifetime risk of breast cancer was only slightly higher than that of the average woman. She never had extensive counseling to examine her fears and whether she was perhaps choosing an irrational course of action. I can’t help but wonder whether such counseling would have changed her decision.