Where I live the major cancer hospital, Roswell Park, actually has an advertisement essentially saying before you get surgery/have your breasts removed, please go talk to them to talk about other options. Surgery might not be necessary at all. I'm pretty proud of them for that.
People in the future are going to find such medical procedures we have now as ridiculous as how we find ancient medical procedures like bloodletting ridiculous.
I get it, this is a medical show. But it is important to take into account what the patient wants as well. My mother had both breasts removed, not to extend her life, but because she did not want to keep one if she could not keep both. For her, having no breasts feels less bad than having one breast. For other women, they want symmetry. Two reconstructed breasts look more similar to each other than one original breast and one reconstructed breast. Most women, and most people in general, find symmetry to be "better looking" and when it's their own body, this should be respected. If this video is advocating for advising breast cancer victims that getting rid of the cancer-free breast is unnecessary, and doing so comes with addition risks, fine. But complaining about the high rate of healthy breast removal is wrong. If a person feels that having both removed looks and/or feels better, that person should have both breast removed. And since the vast majority of people feel this way, expect this too continue at high rates, don't complain about it, and respect the decisions of those who choose to do it.
+abrahamchapman I agree with your points, but I want to add some clarification. "Prophylaxis" by definition means it is designed to prevent disease and more importantly improve patient-related-outcomes (i.e. survival rates as mentioned in the video). Therefore, a prophylactic contralateral mastectomy is ineffective in regards to comabating breast cancer. I agree with you and others who have posted that cosmetics is important and revelant for a patient, and a bilateral mastectomy can certainly be the right choice for a patient who only requires a unilateral one. However, the contralateral mastectomy would be cosmetic and not prophylactic. That's an important point to make, as additional procedures come with risks. This video communicates to me that doctors and patients should better acknowledge that a contralateral mastectomy is not effective prophylaxis based on current data.
+Peter Karalis I appreciate your clarification on the use of the term 'prophylactic' and to pick up on the first commenter's point, I don't think it was explained well enough to the audience the difference. I also feel the second commenter is very on point to the real world issue of this. I have to wonder if the rate of reported prophylactic removal isn't skewed by patients need to have the procedure covered by medical insurance? I think it's quite likely patients would prefer a symmetrical look, both for their self confidence and their psychological well being. To achieve this desire, patients may be reporting the procedure as prophylactic to ensure It will be covered by their insurance, rather than not covered when the patient is 'honest' and admits the surgery is 'elective'.
I would think some women are claiming they want the other breast removed for medical reasons so it's covered by insurance, but really they want it for cosmetic reasons (one breast is weird and awkward - especially if one is larger than a C cup).
+Eristitia Sometimes, yes. Sometimes the insurance gives you a nice letter stating it won't be covered because it's "considered experimental or investigational, the treatment is not medically necessary, or the treatment is not the standard of care". Then you can appeal, and the doctor can appeal (separately), but the insurance can still deny on the basis that the one boob that's left is perfectly fine (but, they might pay to get an implant for the one that was removed).
+Lehanna Allen Yup. Based on the data against this procedure, and my wife's experience with her doctor "sneaking things through the system" (though not for breast cancer), I'd be shocked if it wasn't the case that very nearly 100% of the cases of medically unnecessary bilateral removal - that are pushed through as medically necessary - are being done to cheat the insurance companies. Given that this is happening anyway, I think it's time for the insurance companies to just concede this point and pay for bilateral breast reconstruction by default, with the patient and their doctor choosing whether or not they want to accept the extra risk. They payments will continue either way (though lies like is happening today), so it's not a monetary loss to the insurance companies. It will, however, make the insurance companies look great if they do this while also easing the burden of doctors and patients.
I love your show but especially in this episode I'm seeing too much medical jargon. I also get a bit lost in the statistics and data. I think the data could be displayed as graphs or other visual data that can you can see the differences at a glance. The words could use a little more introduction. This would increase the time a bit and I don't know how much your trying to fit into a time slot. Also I don't remember if you have a generic introduction explanation of the science words but that might also be a good idea for first time viewers and people who haven't heard you explain them yet.
Were these all purely cautionary decisions? Or were they more an issue of balancing? Had these women already had one breast removed? Because at that point, I could kinda get just having the other removed as well... That doesn't change the risks that are apparently not being weighed, but it would be an interesting variable to see presented additionally.
That's exactly what I would want done. I wouldn't want an artificial breast or an asymmetrical chest. If the removed one could be partially recreated using my own cells, that would be great, so long as they match in size. Symmetry is more important to me than size, even if that means having no breasts at all.
Awesome Video, as Always! ^_^ +Sydd Linden 00:45 He states that ..."69% of the women who had the procedure performed had neither of these risk factors." So yes - it is cautionary, but greatly unnecessary. It all revolves around the necessity of the procedure. It's a discussion of the phantom caution actually causing more real problems than it solves. The Majority of women who have a singular procedure HAVE to. You don't call two of a single mastectomy Bilateral. It's a different procedure. They would have had two singular mastectomies. I don't think this is taking cosmetic surgery into account; he mentions Reconstruction later. On having a pair removed as 'better' or 'preferred' to singularly ... Let's say the doctor says you have to have an ear removed For Caution's sake, even though your scan is clean. Would you like him to lop off the other, I could kinda get just having the other removed a well... you know, balance.
+NatAnn64 I understand all that. That's not what I was asking. I wondered what percentage of those made the choice FOR, essentially, cosmetic reasons, because that's not something that he mentioned. That's all. I've thought about this myself, and if I had to lose one, then just take the other and I'll be done with bras forever. It's not the same as ears. And it wouldn't be a precaution, it would really be a cosmetic choice on my part. I completely understand what he's saying about the precaution not actually helping medically. I wondered about specifics of such a discission that weren't discussed in depth in the video.
+Sydd Linden This is a good question and I found a study that asked women just that. www.ncbi.nlm.nih.gov/pubmed/10493622 At least 10% do it for desire for cosmetic symmetry and another 32% are because of "a combination of all of these reasons". If we remove the 30% who got it for the "right reasons", increase genetic risk, and the 11% who did not give an answer, it could possible be as much as 71% where cosmetic played a factor. Or though only ~19% as the solo give reason, of women who medical should not have got it but did and gave a reason.
You have to deal with parents and their fears, so it should be clear that people's fears put pressure upon better medical advice, (as well as other forms of inertia that push for CPMs.) Thank you for providing a nice reference video that can help improve patience choices.
That's weird. If your dentist pulled a tooth to get rid of an abcess, then advised pulling the _next_ tooth in case the infection came back...I think you'd look for a new dentist.
I respect the effort and concern that is displayed by this channel; it often publishes very significant data. However, I recommend even more use of common vocabulary terms if the intent is to reach the general public; if I misunderstand that intention, then read no further. I recognize that most of the time there are "plain language" descriptions of the issues and procedures included, but there is still a preponderance of technical terminology that might not only seem obscure to many people but may also be offputting in terms of how much of a video they choose to watch, especially as the jargon often arrives rapidly and in connected strings. ~ It is common that members of particular professions become so accustomed to the specialized diction that is selected for scientific or legal clarity that they become inured to its technical and arcane qualities. Even a title that begins with words like _prophylactic_ and _contralateral_ will likely have more traction with clinical professionals than the man on the street. I suppose, then, that I am not only recommending more plain language, but also less of the argot. ~ In any event, thanks for the channel.
Our pathologist said she would get both breasts removed if one had cancer because she feels like she sees too many patients come back with cancer in the other breast so I find this really interesting
This is what makes me afraid to use doctors and hospitals. I find myself doubting if the prescribed treatment will help or make the problem worse. Ive already had one root canal on the wrong tooth,
The default assumption by Americans and their physicians is that doing something is better than doing nothing. Even when it's not. Even when the something is worse than nothing.
It's naive to think that the only reason woman are having the contralateral breast removed is purely for "just in case" safety reasons. My guess is the majority of the women who had this procedure done was for cosmetic reasons. I imagine it would be strange to have only one breast removed, even if reconstruction was performed after removal. We shouldn't be shaming these women who want to return to normal life as much as possible. Nor should we be shaming their doctors. I think having bilateral mastectomy, followed by reconstruction or not, probably helps them to do that.
+Matt Walker I'm sure many women do take that into account, but I doubt "the majority" of women have it done specifically for cosmetic reasons and no other reason. It's also naive to think someone who has been told they have cancer isn't taking their life into consideration. No one would want to experience again the news that their body may very well kill them. So it's more likely people believe they're getting a greater benefit by *both* eliminating the risk of the other breast and evening themselves out, especially since they're going under the knife anyways might as well get both right? Though now we know that's a misleading line of thought and they may be taking on more risk by going through that surgery.
Matt walker because of an infection I couldn't get reconstriction right away....I have only one breast and I feel like a freak, I want it gone! I 'd rather be completely flat😞
I see some people speculating that this may be for cosmetic reasons, but is it really that bad to get surgeries for (so called) cosmetic reasons? I feel like this mindset may prevent people from getting medically necessary surgeries. For example, I'm transgender and would like to get a double mastectomy to reduce body dysphoria, but every doctor I talk to seems to think that is only a cosmetic surgery and not medically necessary. Just putting it out there that we don't know why these people are getting contralateral prophylactic mastectomies, and if they're getting it to reduce body dysphoria of having removed one breast then it may be useful. Although this is merely further speculation.
I can bet that Anjelina Jolie and Christina Applegate played a huge role on this. I respect these women for sharing their experiences with breast cancer. I believe Christina tested positive for cancer or for the gene. Jolie, just the gene as far as I know. But what they didn't share is that their experiences are not universal. And they have money to throw away on reconstructive surgery if they want to most women do not.
+yin ng Because she DOES have a gene that is known to increases the risk for breast cancer. (Unless you are genuinely concerned for her as a person, I can reassure you that none of her films are going to suffer with current computer editing of film. Actually her operation probably increases the number of future films in which she will exist.)
Where I live the major cancer hospital, Roswell Park, actually has an advertisement essentially saying before you get surgery/have your breasts removed, please go talk to them to talk about other options. Surgery might not be necessary at all.
I'm pretty proud of them for that.
People in the future are going to find such medical procedures we have now as ridiculous as how we find ancient medical procedures like bloodletting ridiculous.
They still have _blood_? That's disgusting! Not to mention grossly inefficient.
+GuyWithAnAmazingHat Well yah but that doesn't help us now.
I get it, this is a medical show. But it is important to take into account what the patient wants as well.
My mother had both breasts removed, not to extend her life, but because she did not want to keep one if she could not keep both. For her, having no breasts feels less bad than having one breast. For other women, they want symmetry. Two reconstructed breasts look more similar to each other than one original breast and one reconstructed breast. Most women, and most people in general, find symmetry to be "better looking" and when it's their own body, this should be respected.
If this video is advocating for advising breast cancer victims that getting rid of the cancer-free breast is unnecessary, and doing so comes with addition risks, fine. But complaining about the high rate of healthy breast removal is wrong. If a person feels that having both removed looks and/or feels better, that person should have both breast removed. And since the vast majority of people feel this way, expect this too continue at high rates, don't complain about it, and respect the decisions of those who choose to do it.
+abrahamchapman I agree with your points, but I want to add some clarification. "Prophylaxis" by definition means it is designed to prevent disease and more importantly improve patient-related-outcomes (i.e. survival rates as mentioned in the video). Therefore, a prophylactic contralateral mastectomy is ineffective in regards to comabating breast cancer.
I agree with you and others who have posted that cosmetics is important and revelant for a patient, and a bilateral mastectomy can certainly be the right choice for a patient who only requires a unilateral one. However, the contralateral mastectomy would be cosmetic and not prophylactic. That's an important point to make, as additional procedures come with risks.
This video communicates to me that doctors and patients should better acknowledge that a contralateral mastectomy is not effective prophylaxis based on current data.
+Peter Karalis I appreciate your clarification on the use of the term 'prophylactic' and to pick up on the first commenter's point, I don't think it was explained well enough to the audience the difference. I also feel the second commenter is very on point to the real world issue of this. I have to wonder if the rate of reported prophylactic removal isn't skewed by patients need to have the procedure covered by medical insurance? I think it's quite likely patients would prefer a symmetrical look, both for their self confidence and their psychological well being. To achieve this desire, patients may be reporting the procedure as prophylactic to ensure It will be covered by their insurance, rather than not covered when the patient is 'honest' and admits the surgery is 'elective'.
abrahamchaptman Thank you!!!!! I am in the first case, I rather have no breast than only one and I do have cancer😉
anyone else chuckle at the typo starting 1:42?
I didn't catch it, but I see it now... Anals lol
I would think some women are claiming they want the other breast removed for medical reasons so it's covered by insurance, but really they want it for cosmetic reasons (one breast is weird and awkward - especially if one is larger than a C cup).
Insurance usually covers reconstructive surgery.
+Eristitia Sometimes, yes. Sometimes the insurance gives you a nice letter stating it won't be covered because it's "considered experimental or investigational, the treatment is not medically necessary, or the treatment is not the standard of care". Then you can appeal, and the doctor can appeal (separately), but the insurance can still deny on the basis that the one boob that's left is perfectly fine (but, they might pay to get an implant for the one that was removed).
+Lehanna Allen Yup. Based on the data against this procedure, and my wife's experience with her doctor "sneaking things through the system" (though not for breast cancer), I'd be shocked if it wasn't the case that very nearly 100% of the cases of medically unnecessary bilateral removal - that are pushed through as medically necessary - are being done to cheat the insurance companies.
Given that this is happening anyway, I think it's time for the insurance companies to just concede this point and pay for bilateral breast reconstruction by default, with the patient and their doctor choosing whether or not they want to accept the extra risk. They payments will continue either way (though lies like is happening today), so it's not a monetary loss to the insurance companies. It will, however, make the insurance companies look great if they do this while also easing the burden of doctors and patients.
I love your show but especially in this episode I'm seeing too much medical jargon. I also get a bit lost in the statistics and data.
I think the data could be displayed as graphs or other visual data that can you can see the differences at a glance.
The words could use a little more introduction. This would increase the time a bit and I don't know how much your trying to fit into a time slot. Also I don't remember if you have a generic introduction explanation of the science words but that might also be a good idea for first time viewers and people who haven't heard you explain them yet.
But what about the look of it? Surely they'd want symmetry in the chesticles.
That's a fine patient choice. But most are not doing it for that reason.
+Vicvic W I think it would be easier to get an implant in the removed breast, since you're already doing a lot of cutting on that side.
"Chesticles"
I'm so using that! XD
+Vicvic W I was thinking this too.
Were these all purely cautionary decisions? Or were they more an issue of balancing? Had these women already had one breast removed? Because at that point, I could kinda get just having the other removed as well...
That doesn't change the risks that are apparently not being weighed, but it would be an interesting variable to see presented additionally.
That's exactly what I would want done. I wouldn't want an artificial breast or an asymmetrical chest. If the removed one could be partially recreated using my own cells, that would be great, so long as they match in size. Symmetry is more important to me than size, even if that means having no breasts at all.
Awesome Video, as Always! ^_^
+Sydd Linden
00:45 He states that ..."69% of the women who had the procedure performed had neither of these risk factors."
So yes - it is cautionary, but greatly unnecessary. It all revolves around the necessity of the procedure. It's a discussion of the phantom caution actually causing more real problems than it solves.
The Majority of women who have a singular procedure HAVE to.
You don't call two of a single mastectomy Bilateral. It's a different procedure. They would have had two singular mastectomies.
I don't think this is taking cosmetic surgery into account; he mentions Reconstruction later.
On having a pair removed as 'better' or 'preferred' to singularly ... Let's say the doctor says you have to have an ear removed For Caution's sake, even though your scan is clean. Would you like him to lop off the other, I could kinda get just having the other removed a well... you know, balance.
+NatAnn64 I understand all that. That's not what I was asking. I wondered what percentage of those made the choice FOR, essentially, cosmetic reasons, because that's not something that he mentioned. That's all.
I've thought about this myself, and if I had to lose one, then just take the other and I'll be done with bras forever. It's not the same as ears. And it wouldn't be a precaution, it would really be a cosmetic choice on my part.
I completely understand what he's saying about the precaution not actually helping medically. I wondered about specifics of such a discission that weren't discussed in depth in the video.
+Sydd Linden This is a good question and I found a study that asked women just that.
www.ncbi.nlm.nih.gov/pubmed/10493622
At least 10% do it for desire for cosmetic symmetry and another 32% are because of "a combination of all of these reasons". If we remove the 30% who got it for the "right reasons", increase genetic risk, and the 11% who did not give an answer, it could possible be as much as 71% where cosmetic played a factor. Or though only ~19% as the solo give reason, of women who medical should not have got it but did and gave a reason.
+Loathomar Thank you for the info! That's exactly what I was wondering.
You have to deal with parents and their fears, so it should be clear that people's fears put pressure upon better medical advice, (as well as other forms of inertia that push for CPMs.) Thank you for providing a nice reference video that can help improve patience choices.
That's weird. If your dentist pulled a tooth to get rid of an abcess, then advised pulling the _next_ tooth in case the infection came back...I think you'd look for a new dentist.
I respect the effort and concern that is displayed by this channel; it often publishes very significant data. However, I recommend even more use of common vocabulary terms if the intent is to reach the general public; if I misunderstand that intention, then read no further. I recognize that most of the time there are "plain language" descriptions of the issues and procedures included, but there is still a preponderance of technical terminology that might not only seem obscure to many people but may also be offputting in terms of how much of a video they choose to watch, especially as the jargon often arrives rapidly and in connected strings.
~
It is common that members of particular professions become so accustomed to the specialized diction that is selected for scientific or legal clarity that they become inured to its technical and arcane qualities. Even a title that begins with words like _prophylactic_ and _contralateral_ will likely have more traction with clinical professionals than the man on the street. I suppose, then, that I am not only recommending more plain language, but also less of the argot.
~
In any event, thanks for the channel.
Our pathologist said she would get both breasts removed if one had cancer because she feels like she sees too many patients come back with cancer in the other breast so I find this really interesting
This is what makes me afraid to use doctors and hospitals. I find myself doubting if the prescribed treatment will help or make the problem worse. Ive already had one root canal on the wrong tooth,
Are they getting it to reduce the risk?
Could it be related to vanity and getting fake boobs after a mastectomy?
I would need this surgery, since a lot of women on both sides of my family have had breast cancer.
"Not helping, no one seems to care." As sad as it is when you say it, it's amazing how often you don't say it.
The default assumption by Americans and their physicians is that doing something is better than doing nothing. Even when it's not. Even when the something is worse than nothing.
It's naive to think that the only reason woman are having the contralateral breast removed is purely for "just in case" safety reasons. My guess is the majority of the women who had this procedure done was for cosmetic reasons.
I imagine it would be strange to have only one breast removed, even if reconstruction was performed after removal. We shouldn't be shaming these women who want to return to normal life as much as possible. Nor should we be shaming their doctors. I think having bilateral mastectomy, followed by reconstruction or not, probably helps them to do that.
+Matt Walker I'm sure many women do take that into account, but I doubt "the majority" of women have it done specifically for cosmetic reasons and no other reason. It's also naive to think someone who has been told they have cancer isn't taking their life into consideration. No one would want to experience again the news that their body may very well kill them. So it's more likely people believe they're getting a greater benefit by *both* eliminating the risk of the other breast and evening themselves out, especially since they're going under the knife anyways might as well get both right? Though now we know that's a misleading line of thought and they may be taking on more risk by going through that surgery.
Matt walker because of an infection I couldn't get reconstriction right away....I have only one breast and I feel like a freak, I want it gone! I 'd rather be completely flat😞
I see some people speculating that this may be for cosmetic reasons, but is it really that bad to get surgeries for (so called) cosmetic reasons? I feel like this mindset may prevent people from getting medically necessary surgeries. For example, I'm transgender and would like to get a double mastectomy to reduce body dysphoria, but every doctor I talk to seems to think that is only a cosmetic surgery and not medically necessary. Just putting it out there that we don't know why these people are getting contralateral prophylactic mastectomies, and if they're getting it to reduce body dysphoria of having removed one breast then it may be useful. Although this is merely further speculation.
Unnecessary medical procedures make $, while telling people they don't need them doesn't.
Aaron's zipper alignment was oddly satisfying.
I can bet that Anjelina Jolie and Christina Applegate played a huge role on this. I respect these women for sharing their experiences with breast cancer. I believe Christina tested positive for cancer or for the gene. Jolie, just the gene as far as I know. But what they didn't share is that their experiences are not universal. And they have money to throw away on reconstructive surgery if they want to most women do not.
Angelina**
"saving the tatas" has become big business
Yeah... but... symmetry!
How could we tell who's doing it for false beliefs about health and who's doing it so their boobs (or lack thereof) are even?
Wow, what a shame.
I literally have no interest in Contralateral prophylactic mastectomies whatsoever, I just like watching Aaron get mad at unnecessary surgeries.
I'll keep this in mind if anyone I know gets breast cancer.
Why didn't you call Angelina Jolie before she went into for one of such? 😯 ;)
+yin ng Because she DOES have a gene that is known to increases the risk for breast cancer. (Unless you are genuinely concerned for her as a person, I can reassure you that none of her films are going to suffer with current computer editing of film. Actually her operation probably increases the number of future films in which she will exist.)
It seems to me that surgeons have an ethical obligation to refuse to perform these procedures.
Hal....You are a man!!!! I dare you making comments on breasts....