Double Mastectomy No Guarantee Against Breast Cancer Recurrence

McClatchy-Tribune Information Services -- Unrestricted

Bobby Caina Calvan

October 17, 2009

At 15, she watched an aunt struggle with breast cancer. Then a cousin. Soon after, Mattie McCalister was stricken with the same disease that would afflict so many of the women in her family.

Her first sign of cancer was a lump the size of a small egg in her left breast. "That began my spiral," she said. "It was really rough not knowing if I was going to live or if I was going to die. At that age, I had just begun to live."

At first, McCalister rejected her doctor's advice for a mastectomy. But after eight years of surgery after surgery to remove recurring lumps, McCalister had both breasts removed. She was 23 years old and the mother of a baby girl. "I decided to have a double mastectomy and get it over with," she said.

Decades later, her ordeal has begun anew.

At 59, her cancer is back. It's a sobering reminder, her doctor said, that double mastectomy is no guarantee against recurrence of the disease.

Doctors have been confounded recently by a rise in double mastectomies, even though many are unnecessary and there is little evidence that removing both breasts -- when only one is cancerous -- reduces the chance of death.

"Just because you have a mastectomy, you don't bring your risk of breast cancer down to zero," said Dr. Anthony Pu, a radiation oncologist with Radiological Associates of Sacramento who is treating McCalister in her latest bout with the disease.

After years of decline, the number of double mastectomies appears to be increasing, despite advances in surgical techniques and less-invasive treatments.

In a 2007 study published in the Journal of Clinical Oncology, researchers said double mastectomies in the United States more than doubled from 1998 to 2003. Researchers said more studies were needed "to understand the decision-making processes that have led to more aggressive breast cancer surgery."

The trend appears to be driven by patients, said Dr. Richard Bold, who runs the oncology surgery program at UC Davis Cancer Center.

"We seldom recommend it, in the absence of a diagnosis" that the second breast is cancerous, he said.

Certainly, removing a breast reduces the chance that cancer will develop in it, but the risk remains.

"When I see these patients, I understand their fears," Pu added. "But their fears are driving them to have more surgery and mutilation of their bodies without any proven decrease in breast cancer mortality."

From McCallister's point of view, the simple fact that she's alive illustrates the importance of self-exams.

"Early detection is probably the only reason I'm here," she said.

Every few months, she tells her story to patients from four health clinics she oversees for Molina Health Care. She urges women to examine themselves and get mammograms.

"I tell women to go back home, talk their mothers, talk to their sisters, to find out who in their family have had the disease, because it usually runs in the family," she said.

This Sunday, McCallister joins other breast cancer survivors and their families for an annual fundraising 5K walk, "Making Strides Against Breast Cancer," one of many events commemorating Breast Cancer Awareness Month.

Two of her sisters have also been diagnosed with breast cancer. A third sister has had cysts removed, all benign, and worries daily the next lump could be cancerous.

The women are thankful that their youngest sister has been spared. "We thank God for that," McCalister said.

Their mother, however, has not. At 79, she was diagnosed with cancer and had her left breast removed. Now 82 and living in Mississippi, she has not been told of McCalister's new cancer.

"It would devastate her. Her heart can't take it," said Adline Tatum, one of McCalister's sisters.

McCalister doesn't know why her cancer appeared so early in life, a rarity, according to statistics.

"In the back of your mind, you never say you're 100 percent cured. But I thought I was free, even if you never really know," she said.

On Jan. 17, she had just returned home from her father's funeral.

She reclined on her couch and raised her arm, she recalled, and began one of her periodic self-examinations.

"I just buried my dad, and I was thinking that life's too short," she said.

She found a lump.

"I didn't have time to grieve -- because I was starting another journey," McCalister said. "I was going to go through a lot of things. -- It was going to be another uphill climb."

------

Call The Bee's Bobby Caina Calvan, (916) 321-1067. To see more of The Sacramento Bee, or to subscribe to the newspaper, go to http://www.sacbee.com/. Copyright (c) 2009, The Sacramento Bee, Calif. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Copyright (C) 2009, The Sacramento Bee, Calif.